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The Florida Supervision Report form plays a crucial role in the state's correctional system, serving as a comprehensive tool for monitoring individuals under supervision. This form captures essential information about the individual, including their name, DC number, and contact details. It also requires details about their residence, including the address and the names and relationships of others living there, particularly noting if anyone else is under supervision. Employment information is another key aspect, detailing the individual's job title, duties, and income earned. Additionally, the form addresses educational pursuits, outlining the type of classes or schools attended, along with enrollment dates. The report emphasizes the importance of tracking progress on special conditions of supervision, such as public service hours and treatment attendance. Furthermore, it encourages individuals to reflect on their interactions with law enforcement and to set personal goals, outlining specific action steps taken and planned for the future. This holistic approach ensures that the supervision process remains focused on rehabilitation and accountability, fostering a pathway toward successful reintegration into society.
Form Example
FLORIDA DEPARTM ENT OF CORRECTIONS
SUPERVISION REPORT
(FOR THE M ONTH OF ____________________)
NAM E: ___________________________________________________________ |
DC#: ________________________________________ |
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OFFICER NAM E/ LOCATION: ______________________________________________________________________________________________ |
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RESIDENCE: |
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St reet Address: ________________________________________________ Cit y: _____________________________ |
Zip: _____________ |
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Building: ______________ |
Apt #: ______________ |
Lot#: _____________ |
Code t o access securit y gat e: _____________________ |
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LIST FULL NAM ES, AGES, AND RELATIONSHIP OF OTHERS WHO CURRENTLY LIVE AT THIS RESIDENCE (Note if anyone is on supervision):
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________________________________________________________ |
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HOM E PHONE NUM BER: |
CELLULAR PHONE NUM BER: |
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EM AIL ADDRESS: |
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M AILING ADDRESS (IF DIFFERENT FROM RESIDENCE): |
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VEHICLE - ____________________________________________________________________________________________________________
M AKE |
M ODEL |
YEAR |
COLOR |
TAG# |
CHECK CURRENT STATUS OF DRIVER’S LICENSE:
Valid
Revoked (Date:__________________)
Suspended (Date:_____________)
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EM PLOYM ENT:
Employer Name: ___________________________________________ |
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Supervisor Name: |
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Phone: |
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Employment Address: |
____________________________________________________________________________________________ |
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St reet |
Cit y |
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Zip |
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Your job tit le: _________________________________________________________________________________________________________
Job Dut ies: ___________________________________________________________________________________________________________
SALARY/ INCOM E EARNED (for past month): ____________________ DATE BEGAN:DATE ENDED: ________________
Typical Days/ Hours W orked: _____________________________________________________________________________________________
NOTE: If unemployed (and not retired, disabled or a
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STUDENT/ SCHOOL:
N/ A
Type of Class/ School Att ending:
High School
College
Adult Educat ion
Vocat ional
Ot her Course
Online Classes
School/ Class Name: ___________________________________________________ |
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Phone#: |
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Address: |
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Cit y |
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Tot al Semest er/ Quart er Hours Enrolled: |
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Dat e Class or Semest er Began: |
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Dat e Ended: |
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(At t ach proof of enrollment or ending report) |
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Page 1 of 2 - Please complete the other/ reverse side of this report (OVER)
Incorporat ed by Reference in Rule |
2 Part |
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6 Part |
SPECIAL CONDITIONS OF SUPERVISION – List progress made t his past month on special condit ions ordered, including:
PUBLIC SERVICE HOURS: ______________________ M ONETARY PAYM ENT: ______________________ OTHER: ______________________
TREATM ENT ATTENDED THIS PAST M ONTH: ________________________________________________________________________________
NOTE: At tach required Support Group At tendance forms, driving logs, public service work document at ion, et c. as required.
PAYM ENTS: Payments may be made by either U. S. M ail or credit card using one of the services described on the DC Public W eb site, w w w .dc.state.fl.us under the Probation link “FAQS” - Frequently Asked Questions– Four Ways to Pay Court Ordered Payments.
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CONTACT W ITH LAW ENFORCEM ENT – If you had any cont act w it h law enforcement t his past mont h, explain details here: _________________
_____________________________________________________________________________________________________________________
Do you have a problem or concern you w ould like to discuss w ith your probation officer?
YES
NO
How did you spend your free time last month? _________________________________________________________________________________
____________________________________________________________________________________________________ ____________________
PERSONAL GOALS: W rite each of your top 2 goals you are w orking to achieve. Indicate at least 2 action steps you took last m onth and 2 action steps you w ill take this m onth to achieve each goal.
GOAL # 1:
________________________________________________________________________________________________________________________
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ACTION STEPS I TOOK LAST M ONTH:
1.__________________________________________________________________________________
2.__________________________________________________________________________________
ACTION STEPS I W ILL TAKE THIS M ONTH:
1.__________________________________________________________________________________
2.__________________________________________________________________________________
GOAL # 2:
____________________________________________________________________________________________________ ____________________
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ACTION STEPS I TOOK LAST M ONTH:
1.__________________________________________________________________________________
2.__________________________________________________________________________________
ACTION STEPS I W ILL TAKE THIS M ONTH:
1.__________________________________________________________________________________
2.__________________________________________________________________________________
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Signature |
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Date |
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Signature of Officer Receiving Report |
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Date Report Review ed |
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Officer Comments: |
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Incorporat ed by Reference in Rule |
Document Breakdown
| Fact Name | Description |
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| Purpose | The Florida Supervision Report form is used to document an individual's compliance with the terms of their supervision, including employment, education, and any special conditions set by the court. |
| Governing Law | This form is incorporated by reference in Rule 33-302.110 of the Florida Administrative Code. |
| Required Information | The report requires personal details such as the individual's name, DC number, contact information, and residence details, as well as information about household members. |
| Employment Reporting | Individuals must report their employment status, including the name of their employer, job title, and salary earned for the past month. |
| Contact with Law Enforcement | Individuals are required to disclose any contact with law enforcement during the reporting period, providing details as necessary. |
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