3 2026 DC3

User Manual: 3-2026

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FLORIDA DEPARTMENT OF CORRECTIONS

SUPERVISION REPORT
(FOR THE MONTH OF ____________________)
NAME: ___________________________________________________________

DC#: ________________________________________

OFFICER NAME/LOCATION: ______________________________________________________________________________________________
RESIDENCE:
Street Address: ________________________________________________
Building: ______________

Apt#: ______________

City: _____________________________

Lot#: _____________

Zip: _____________

Code to access security gate: _____________________

LIST FULL NAMES, AGES, AND RELATIONSHIP OF OTHERS WHO CURRENTLY LIVE AT THIS RESIDENCE (Note if anyone is on supervision):
________________________________________________________

________________________________________________________

________________________________________________________

________________________________________________________

HOME PHONE NUMBER:

CELLULAR PHONE NUMBER:

EMAIL ADDRESS:
MAILING ADDRESS (IF DIFFERENT FROM RESIDENCE):
VEHICLE - ____________________________________________________________________________________________________________
MAKE
MODEL
YEAR
COLOR
TAG#
CHECK CURRENT STATUS OF DRIVER’S LICENSE:
Valid
Revoked (Date:__________________)
Suspended (Date:_____________)
*********************************************************************************************************************
EMPLOYMENT:
Employer Name: ___________________________________________

_____________

Supervisor Name:
Employment Address:

Phone:

____

____________________________________________________________________________________________
Street
City
State
Zip

Your job title: _________________________________________________________________________________________________________
Job Duties: ___________________________________________________________________________________________________________
SALARY/INCOME EARNED (for past month): ____________________ DATE BEGAN:

DATE ENDED: ________________

Typical Days/Hours Worked: _____________________________________________________________________________________________
NOTE: If unemployed (and not retired, disabled or a full-time student), attach completed Job Search form or list for the month.
*********************************************************************************************************************
STUDENT/SCHOOL:
N/A
Type of Class/School Attending:

High School

College

Adult Education

School/Class Name: ___________________________________________________

Vocational

Other Course

Online Classes

Phone#:

Address:

____________________________________________________________________________________________
Street
City
State
Zip
Total Semester/Quarter Hours Enrolled:
Date Class or Semester Began:
Date Ended:
(Attach proof of enrollment or ending report)
*********************************************************************************************************************
Page 1 of 2 - Please complete the other/reverse side of this report (OVER)
DC3-2026 (Effective 2/14)
Incorporated by Reference in Rule 33-302.110, F.A.C.
2 Part File-Right Side
6 Part File-Section 2

SPECIAL CONDITIONS OF SUPERVISION – List progress made this past month on special conditions ordered, including:
PUBLIC SERVICE HOURS: ______________________ MONETARY PAYMENT: ______________________ OTHER: ______________________
TREATMENT ATTENDED THIS PAST MONTH: ________________________________________________________________________________
NOTE: Attach required Support Group Attendance forms, driving logs, public service work documentation, etc. as required.
PAYMENTS: Payments may be made by either U. S. Mail or credit card using one of the services described on the DC Public Web site,
www.dc.state.fl.us under the Probation link “FAQS” - Frequently Asked Questions– Four Ways to Pay Court Ordered Payments.
*********************************************************************************************************************
CONTACT WITH LAW ENFORCEMENT – If you had any contact with law enforcement this past month, explain details here: _________________
_____________________________________________________________________________________________________________________
Do you have a problem or concern you would like to discuss with your probation officer?

YES

NO

How did you spend your free time last month? _________________________________________________________________________________
________________________________________________________________________________________________________________________
PERSONAL GOALS: Write each of your top 2 goals you are working to achieve. Indicate at least 2 action steps you took last month and 2 action
steps you will take this month to achieve each goal.
GOAL # 1:
________________________________________________________________________________________________________________________
__________________________________________________
ACTION STEPS I TOOK LAST MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
ACTION STEPS I WILL TAKE THIS MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
GOAL # 2:
________________________________________________________________________________________________________________________
__________________________________________________
ACTION STEPS I TOOK LAST MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________
ACTION STEPS I WILL TAKE THIS MONTH:
1. __________________________________________________________________________________
2. __________________________________________________________________________________

________

_____________

Signature

Date

Signature of Officer Receiving Report

Date Report Reviewed

Officer Comments:

DC3-2026 (Effective 2/14)

Incorporated by Reference in Rule 33-302.110, F.A.C.
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