Logo Agency/ Company Name

Address
Contact Details

1st POST-PLACEMENT REPORT / SUPERVISED TRIAL CUSTODY

REPORT
Family:
Child:
Sex/Age:
Date of Birth / Place of Birth:
Date of Placement:
Date of Supervision/ Visit:
Date of Report:
Date of Next Proposed Visit:

1. Child’s progress, problems (physical, social, emotional, medical):

2. Child’s integration into family and reaction to each family members:

3. Adoptive parent’s adjustment to the child and vice versa:

4. Other children/ family members at home and their reactions to new child; parent’s handling of
children:

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Logo Agency/ Company Name
Address
Contact Details

4. Home condition:

5. Discussion on legal adoption (at appropriate time):

6. Issues/concerns noted during the placement (if any) :

7. Assessment and Recommendation:

Prepared by:

Adoption Social Worker

(Signature over Printed Name)

Approved by:

Head of the Office

(Signature over Printed Name)

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