Special Guardianship Order Assessment Form
Complete this assessment to review the child’s circumstances, current care arrangement, household support, and overall suitability for a Special Guardianship Order.
Child and Placement Details
Child's full name
*
First Name
Middle Name
Last Name
Date of birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current living arrangement
*
How long has the child lived in the current placement?
*
Relationship of applicant/guardian to the child
*
Please Select
Parent
Grandparent
Aunt/Uncle
Sibling
Kinship Carer
Foster Carer
Other
Assessment of Caring Arrangements
Assessment of caring arrangements
*
Rows
Not at all
Partly
Mostly
Fully
Child’s daily care needs
1
2
3
4
Emotional stability and routine
5
6
7
8
Education and school support
9
10
11
12
Health and wellbeing support
13
14
15
16
Contact with birth family
17
18
19
20
Safety and risk management
21
22
23
24
Child’s daily care needs
*
1
2
3
4
Emotional stability and routine
*
1
2
3
4
Education and school support
*
1
2
3
4
Health and wellbeing support
*
1
2
3
4
Contact with birth family
*
1
2
3
4
Household and Support Network
Household members living in the home
*
Availability of support from extended family or friends
*
Strong support available
Some support available
Limited support available
No support available
Relevant practical support arrangements for the placement
Applicant Suitability and Final Assessment
Strengths of the proposed guardianship arrangement
*
Concerns or risks identified
*
Overall suitability rating
*
1
2
3
4
5
Recommended next steps or actions
Assessor name
*
First Name
Middle Name
Last Name
Assessor role
*
Organisation
*
Assessment date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Assessment
Should be Empty: