Home and Premise Check

Home Check Guidelines: These guidelines are not only to insure that all the information that we have been given on an adoption application is correct, but also to help avoid any potential problems/dangerous situations that might be found in common household situations that need to be rectified before the adopted dog comes to live there. Please fill this form out as thoroughly and accurately as possible. This form also serves for the evaluation of potential Foster Homes.

HOMECHECKER

Agency: _______________________________

Rescue Agent: _______________________________________

Address: _______________________________________

_______________________________________

Phone: _________________________________

Email: _________________________________

POTENTIAL ADOPTER

(Please verify the following)

Name: _______________________________________

Address:

_______________________________________

Phone: _________________________________

Email: _________________________________

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VEHICLES:

Are Vehicle tags from a different state? Yes No

If so, why? _____________________________________________________________________________

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Evidence of dogs in vehicles? (hair, crates, toys, towels) Yes No

HOUSE:

Do the storm doors close properly behind you? Yes No

Do the latches work? Yes No

Evidence of dogs being allowed inside often? (dog hair, beds/blankets, toys) Yes No

Do you see damage to the house by the dogs? Yes No

Are there areas of the house that dogs aren’t allowed? Yes No

How are dogs kept out of these areas? _______________________________________________________

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Are there house plants? Yes No

Any potentially toxic plants? Yes No

if so, did you notify the owners? Yes No

Did you see grooming equipment? Yes No

Do they have a first aid kit? Yes No

Where will dog food be stored? ____________________________________________________________

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Can dogs get into storage containers easily? Yes No

Any other household dangers should be noted here: _____________________________________________

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DOG HAZARDS INSIDE:

Is there evidence of small children (toys, food scraps)? Yes No

Are there dangerous articles at dog level? (sewing kits, bobbi pins, wash cloths, sponges,

small trash cans, razor blades) Yes No

At counter level? Point them out. Yes No

Are there exposed electrical cords? Point them out. Yes No

Are there chemicals in the garage, basement or storage areas? Point them out. Yes No

Do the dogs have access to these areas? Yes No

Do the furnishings of the house appear to be dog proof (glass objects at low levels,

expensive rugs, or furniture that could be knocked over easily)? Point them out. Yes No

How is the trash handled in the home? _______________________________________________________

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Can the dog get into the cans? Point them out. Yes No

Any other dog hazards inside should be noted here: _____________________________________________

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FENCE AND YARD:

How big an area is fenced? ________________________________________________________________

Describe fencing materials: ________________________________________________________________

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In your opinion, is this area adequate for this particular breeds exercise requirements? Yes No

Is the area properly shaded? Yes No

Flooring of the dog kennel or yard: _________________________________________________________

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Will digging create major problems with landscaping? Yes No

Are there places where the dog can leap off decks, etc. and get hurt? Yes No

Describe: _______________________________________________________________________

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Is there anything stacked near the fence the dog could climb on to get out? Yes No

Describe: _______________________________________________________________________

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Is there adequate water? Yes No

How is it supplied? ______________________________________________________________________

Are there potential escape routes?

Low places in the fence? Yes No

Evidence of digging at the fence line? Yes No

Holes in fencing? Yes No

Loose fencing? Yes No

Gates mounted too high? Yes No

Other? ________________________________________________________________________

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When you pointed these out to the potential adopter, how did they react? ___________________________

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Do you think they will fix the problems? Yes No

Do you think a dog would have escaped if you had NOT pointed out the problem? Yes No

Are there locks on the gates (against children and thieves)? Yes No

If the driveway is enclosed? Yes No

Is there antifreeze on the driveway? Yes No

Any other fencing/yard dangers should be noted here: ___________________________________________

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DOG HAZARDS OUTSIDE:

What plants are in the dog yard (which might be poisonous)? Point them out. ________________________

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Any sharp objects that could injure the dog in the dog yard? Yes No

Is the water bucket clean? Yes No

Is there fresh water? Yes No

How does the family respond when you pointed out these potential dog hazards? _____________________

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Any other potential outside dog hazards should be noted here: ____________________________________

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NEIGHBORS:

Is the fence shared with neighboring property? Yes No

Do the adopters have a good relationship with their neighbors? Yes No

Are there loose dogs in the neighborhood? Yes No

Are there children in neighboring yards? Yes No

Are there potentially poisonous plants in neighboring yards? Yes No

Are there dogs or livestock on neighboring property? Yes No

Can any of them get into the adopters yard/kennel? Yes No

Describe surrounding area (rural, suburban, urban): _____________________________________________

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What potential hazards are there in the neighborhood/community? _________________________________

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LIVING ARRANGEMENTS:

Where will the dog be when guests come? (Crated in the basement, outside, inside, other?)

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Where will the dogs spend the night? ________________________________________________________

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Where will the dogs spend the day? _________________________________________________________

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Does the day area contain evidence of dogs? Yes No

Is there water in the day area? Yes No

How is waste removed? __________________________________________________________________

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Does the area look recently cleaned? Yes No

INTERACTION WITH CURRENT PETS:

This is the most important part of the interview - how does the adopter interact with his current pets.

Are the current pets well socialized? Yes No

Are they reasonably clean? Yes No

Any evidence of parasites? (excessive chewing, scratching, etc.) Yes No

Are they hand shy in any way? Yes No

Can you touch their ears & tails? Yes No

Are their reactions to you typical for the breed? Yes No

How do they react to strangers in the house? __________________________________________________

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How did they greet you? __________________________________________________________________

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After you have spent some time with them, do they relax and accept your presence? Yes No

How do they react towards their owners? ____________________________________________________

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Do they respond to commands? Yes No

If not, how does the owner handle it? (Are they heavy handed or accepting? Do they force the issue or accept the disobedience?) ________________________________________________________________

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CONCLUSIONS:

Homecheckers, please be absolutely candid in this section

Do you feel the adopter will love & care for the dog properly? ____________________________________

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Do you feel this home will provide a permanent (or foster) home for the dog? ________________________

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If this were your dog, would you commit to this adoption? _______________________________________

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Since we have yet to regret turning down an adopter, does this adoption "feel" right? _________________

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Does the overall appearance of the house/yard give the impression that it is a clean and healthy environment?

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Please use this section for any other comments you have about this family/situation: ___________________

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Rescuing Agent: ________________________________________________ Date ___________________

Adopter/Foster Signature: _________________________________________ Date ___________________