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Social Investigation Collateral Witness Questionnaire

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Submitted on Aug 30, 2026 at 3:50 PM

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Social Investigation Collateral Witness Questionnaire

Case Name^*

Case Number^*

Child(ren)^*

Parent Who Identified You^*

Date Completed^*

SECTION 2 – WITNESS INFORMATION

Full Name^*

Address^*

Country

Street address

Apartment, suite, etc.

Phone^*

Email^*

Age^*

Occupation^*

Employer^*

Marital Status^*

Number of Children^*

Educational Background^*

Collateral Type (check all that apply)^*

Family Member

Friend

Neighbor

Teacher

Coach

Therapist

Medical Provider

Employer

Other

SECTION 3 – RELATIONSHIP TO THE FAMILY

How often do you see the Mother?^*

Daily

Weekly

Monthly

Rarely

Never

How often do you see the Father?^*

Daily

Weekly

Monthly

Rarely

Never

How often do you see the Child(ren)?^*

Daily

Weekly

Monthly

Rarely

Never

How long have you known the Mother?^*

How long have you known the Father?^*

How long have you known the Child(ren)?^*

SECTION 4 – SOURCE OF INFORMATION

My information is based upon:^*

Personal Observation

Information from Mother

Information from Father

Information from Child

Information from Another Person

Approximate percentage based on firsthand observation^*

Approximate percentage based on information from others^*

Identify any important information that you did NOT personally observe^*

Have you reviewed any of the following before completing this questionnaire?^*

Court documents

Social media posts

Emails

Text messages

Reports

Information provided by Mother

Information provided by Father

If yes, provide details^*

SECTION 5 – OBSERVATIONS OF THE CHILD

Child Emotional Functioning^*

Excellent

Good

Fair

Poor

No Basis

Child Behavior^*

Excellent

Good

Fair

Poor

No Basis

Child Social Skills^*

Excellent

Good

Fair

Poor

No Basis

Child School Performance^*

Excellent

Good

Fair

Poor

No Basis

Child Relationship with Mother^*

Excellent

Good

Fair

Poor

No Basis

Child Relationship with Father^*

Excellent

Good

Fair

Poor

No Basis

Please provide specific examples you have personally observed^*

SECTION 6 – OBSERVATIONS OF MOTHER

Appropriate Discipline^*

Yes

No Basis

Emotional Support^*

Yes

No Basis

Affection Toward Child^*

Yes

No Basis

Consistency^*

Yes

No Basis

School Involvement^*

Yes

No Basis

Appropriate Boundaries^*

Yes

No Basis

Describe specific strengths of the Mother you personally observed^*

Describe specific concerns of the Mother you personally observed^*

SECTION 7 – OBSERVATIONS OF FATHER

Appropriate Discipline^*

Yes

No Basis

Emotional Support^*

Yes

No Basis

Affection Toward Child^*

Yes

No Basis

Consistency^*

Yes

No Basis

School Involvement^*

Yes

No Basis

Appropriate Boundaries^*

Yes

No Basis

Describe specific strengths of the Father you personally observed^*

Describe specific concerns of the Father you personally observed^*

SECTION 8 – INTERFERENCE / GATEKEEPING OBSERVATIONS

Negative comments about other parent^*

Yes

Interference with communication^*

Yes

Interference with time-sharing^*

Yes

Child used as messenger^*

Yes

Child exposed to litigation^*

Yes

Child asked to choose^*

Yes

Child asked to keep secrets^*

Yes

Child repeating adult information^*

Yes

Provide specific examples^*

SECTION 9 – SIGNIFICANT EVENTS OR INCIDENTS

Significant Events or Incidents^*

SECTION 10 – ADDITIONAL INFORMATION

Is there anything else the evaluator should know?^*

No assistance received^*

Assistance received from^*

Reason for assistance^*

CERTIFICATION

I understand that this questionnaire may be reviewed by the Court, attorneys, parties, and professionals involved in this matter. I certify that my responses are true and accurate to the best of my knowledge.

Printed Name^*

Signature^*

Sign here

Date^*

Upload Notary Form^*

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