HOME EVALUATION FORM

To the Home Evaluator:
Try to get as much information asked for on this form as possible. Ask questions and get as many details about the home environment as you find appropriate. Some of the questions on this form may not apply to a particular home. Try to bring another Volunteer or friend with you on the home visit, both for the purpose of having another pair of eyes and ears to assist you in making a complete evaluation, and for personal safety. If they don’t currently have pets, try to bring one of your own dogs so that you may observe their behavior around him/her.

Adoption Applicant's Name:
Phone:
Address:

Type of Dwelling:

______ Single family home
______ Townhouse
______ Garden Apartment
______ Condo Community
______ High Rise Apartment
______ Row House

Setting (circle all that apply):

Rural/Semi-rural/Suburban/Semi-urban/Urban/Open Acreage/Waterfront

Highway Frontage/Neighborhood Street/Country Road/City Environment

Property Bordering on Park/Field/Woods

Describe accommodations the home has for a dog and where the dog will be left when owners are away. For example, crate in kitchen/laundry room, baby gate across kitchen door, no crate planned, pen in basement, pen in garage, outdoor run. Include complete description of any pen or kennel (chain link run, dirt run with chicken wire, etc.)

Do they intend to ever leave the dog chained or left unattended in a fenced-in yard?

Describe fencing, if any, and condition/security of fence:

Children: Pay special attention to their behavior, the parents' responses and method of discipline, and the children's interactions with other pets. Note whether parents always supervise young children with other pets, and if the parents seem to expect the child/children to "be responsible" with the pets.

Observe their general behavior among family members and between family members and pets - respectful, hectic, loud, quiet, commanding.

Other pets: Describe apparent health and well being of other family pets. Things to note would be skin or flea problems on other animals, overweight or underweight, type of collar/I.D. other pets have, etc.

Owner interaction with other pets: Describe the relationship family members seem to have with other pets.

What role will the dog play in the applicant's life? Are the other pets treated like family members?

How do the other animals behave?

Does applicant believe that new dog will "train" old dog or vice versa?

If applying for a second dog, has applicant ever owned more than one dog at the same time?

What are the owner's responses to the dog behavior, are they appropriate? How do the animals react to the owners' response?

Do their current pets obey happily? Or do they seem out of control and undisciplined? Do they seem to fear any particular members?

Do the owners appear to know some basic training techniques?

Explain that re-homing a dog is stressful for the dog; that the rescued dog that they want to adopt may have training accidents, even if they are housebroken while they are in foster care, for the first few weeks. Ask the potential Adopter(s) what would they do or how would they react to their new dog having an accident?

Please describe anything additional about the home environment that you feel is pertinent:

Is there anything in general or specifically that would cause you to feel
uncomfortable about placing a dog in this home? If so, why? "Gut feelings"
are considered important!

Would you feel comfortable leaving your own dog with the applicant? Yes/No Explain.

Conclusion:

_______Approve Adoption

_______Do Not Approve Adoption

_______ Adopt after additional counseling of owners and/or modifications to the home environment (describe):

Additional Comments:

Additional Suggestions: If you need to take notes during the visit, please do so discreetly. It is better for the applicant(s) to feel at ease with you so that they will “be to be themselves.” Complete this form after the visit, when you are not in the presence of the prospective adopter(s).

Qualities to note are sincerity, commitment, tolerance of normal dog behavior, honest representation of the home environment, children's behavior with other pets and expected role of children in pet care.

Obtain explanations about the absence of any family member during the home visit. Feel free to ask leading questions to begin productive conversation. Often good conversation will reveal far more than questions!