Monitor Report (Substance)

Report covers month of:

Name of Participant

Number of informal contacts (telephone, etc.) with the participant during this period?

Number of formal contacts with the participant during this period?

Has the participant attended his/her required number of 12 Step Meetings during the month? If no, please explain below.
YesNoUnknown

Has the participant attended his/her required number of Attorney Support Meetings during the month? If no, please explain below.
YesNoUnknown

Is the participant's attitude cooperative? If no, please explain below.
YesNo

In your opinion, has the participant maintained their sobriety? If no, please explain below.
YesNo

Monitor Initials:


Please comment on any instances of non-compliance noted on the previous page, on the participant's overall participation in his/her recovery program (12 Step, family, professional issues), and provide any recommendations you may have as to how FLA can assist you or the participant in any way. Thank you.

Monitor Name / Signature: