io REPUBLIQUE DU CAMEROUN REPUBLIC OF CAMEROON

Paix –Travail – Patrie Peace – Work – Fatherland

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REGION DU CENTRE CENTER REGION
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DELEGATION REGIONALE DES AFFAIRES SOCIALES REGIONAL DELEGATION OF SOCIAL AFFAIRS
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DELEGATION DEPARTEMENTALE DES AFFAIRES DIVISIONAL DELEGATION OF SOCIAL AFFAIRS
SOCIALES DU MFOUNDI FOR MFOUNDI
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CENTRE SOCIAL DE YAOUNDE V- ESSOS SOCIAL CENTER OF YAOUNDE V

N°2023/ /RO/RC/DRAS/DDAS-MFDI/CESO-YDE V

Yaoundé, le_________________

RAPPORT D’OBSERVATION
Concernant :_____________________________________________________________

Objet : __________________________________________________________________

I – IDENTIFICATION DU MINEUR :
Nom et prénom : ______________________________________________
Date et lieu de naissance : __________________________________________
Région d’origine : _________________________________________________
Département : ____________________________________________________
Arrondissement : __________________________________________________
Ethnie : _________________________________________________________
Niveau d’études : _________________________________________________
Profession : _____________________________________________________
Religion : ________________________________________________________
Antécédents judiciaires : ____________________________________________
Antécédents médicaux : _____________________________________________
Situation sociale : ________________________________________________
Résidence : ______________________________________________________
Adresse/contact : _________________________________________________

II – COMPOSITION DE LA FAMILLE
A - Parents :

Père : ______________________________________________________________
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Mère : ______________________________________________________________
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b-Fratrie :

N° NOMS ET Age Situation Profession Lieu de

PRENOMS matrimoniale résidence

01

02

03

04

05

06

07

08

09

10

III- HISTOIRE DE L’INTERESSE

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IV- PERSONNALITE DU MINEUR
a- Aspect physique et psychomoteur
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b- Aspect affectif et caractériel

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c- Aspect intellectuel
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d- Etat de santé
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e- Relation avec les parents,avec ses pairs et avec les travailleurs
sociaux
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V – MOTIF DE L’OBSERVATION
a- Genèse du symptôme
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b- Evolution du symptôme

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VI –ANALYSES
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VII - ORIENTATION GENEERALE DE L’OBSERVATION

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VIII- RECOMMANDATION D’ACTION

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Le Chef de Centre Le Rapporteur