Centar za socijalnu skrb

____________________

ZAPISNIK O OEVIDU NA TERENU

sastavljen dana __________________ godine u ____sati kada je izvren oevid na terenu na
adresi korisnika naknade do zaposlenja _______________________________
na adresi _ ________________________________________,
telefon ili mobitel: _________________________________________________________________.
Oevid na terenu izvren je od strane Pavla Maretia, dipl.iur., djelatnika CZSS akovec:
Tijekom oevida na terenu, u kui/stanu zateeni su sljedee osobe (lanovi obitelji):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
lanovi obitelji koji ive u zajednikom domainstvu:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Stambeni uvjeti obitelji (opis prostora u kojem ive, imovina):
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Prihodi od kojih se lanovi obitelji uzdravaju i rashodi, imovina /pokretna i nepokretna/:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________

Posebne tekoe pojedinog lana obitelji (bolest, promjene u ponaanju i sl.):

__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Ostala zapaanja od strane predstavnika Centra za socijalnu skrb i potreba poduzimanja nekih
mjera ili ostvarivanja prava:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Oitovanje predstavnika obitelji na sastavljeni zapisnik:
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
Dovreno: __________

Predstavnik CZSS:

Predstavnik obitelji:

________________________

_____________________