Neighborhood  

 Describe the setting: RuralSuburbanUrbanSemi-RualSemi-urbanWoodedOpen AcreageWaterfrontHighway frontageNeighborhood street frontageCity EnvironmentProperty borders park/field 

 Addtional comments on the setting:  
  Describe the street: Busy Quiet In-Between Cul-de-sac 
 
Home  
  Type of Dwelling: Single family homeTownhouseCondoTrailerApartmentMulti-family homeDuplexFarm
Other:  
  Is the inside of the home clean and neat? Yes No 
 
  What type of flooring is in the home?  
  How do they feel about accidents on their floors?  
  Is there a basement? Yes No 
 

 If yes, will a dog ever be kept there? Yes No 
 
  Is there a garage? Yes No 
 

 If yes, will a dog ever be kept there? Yes No 
 
  Is there a Yard? Yes No 
 

       If yes, is the yard clean and neat? Yes No 
 

       If yes, will a dog be allowed in the yard unsupervised? Yes No 
 
  Is there a fence? Yes No 
 

 If yes, describe type, height, condition, secure, etc.  
  Is the home a safe (dog proof) environment? Yes No 
 

 Are there any of the following: Open Stairs InsideOpen Deck Rail/StairsSlick/Uncarpeted StairsExposed Electrical CordsPoisonous/Toxic materialsPlantsHot Tub/PoolExposed Cat Litter BoxMouse Traps/BaitSmoking Inside/Full Ashtrays  

 Other or Further Explanation:   
  Will a dog ever be left chained outside unattended? Yes No 
 
  Are there dogs or other animals visibly adjacent to this property Yes No 
 

 If yes, please describe:  
  Is there a dog door leading outside? Yes No 
 

 If yes, will a dog have unlimited access to use it? Yes No 
 
  Where will the dog be kept during the day when you are home and how long will they be kept here?  
  Where will the dog sleept at night?  
  Where will the dog be kept when home alone? If confined, describe in detail and for how long:  
  Where and when will the dog be fed?  
Family  
  Were all members of the household present for the visit? Yes No 
 

 If NO, why were other members not present?  
  Were there children or grandchildren present during the visit? Yes No 
 

 If yes, what were their ages?  

 How did they behave in general and with animals present?  
  Does the adoption application information match up with the physical home check? Yes No 
 
  Were there other pets present during the visit? Yes No 
 

 If yes, what kind?  

 Were they well mannered, groomed and taken care of? Yes No 
 

 In detail, describe each pet including personality, health, over/under weight, wearing a collar/ID tag, any notable behavior such as excessive barking, hyperactivity, biting, etc.  
  Would you entrust an animal of your own to their care? Yes No 
 

 If NO, please explain:  

 If yes, please explain:   
  Does the family appear to be sincere, committed and tolerant of normal dog behavior? Yes No 
 

 If no, please explain:  
  Was there anything that you saw or heard that made you feel concerned or uneasy about a dog being placed in this home? Yes No 
 

 If yes, please explain:  
  PLEASE WRITE A SUMMARY OF THIS HOME VISIT:  

 Additional comments: Any special needs, unusual circumstances or concerns that we should consider?: