HV EVALUATION FORM

[Pat Hairston]

HOME EVALUATION FORM BLANK

HOME EVALUATION FORM BLANK-FORM FILL

HOME EVALUATION FORM

To the Home Evaluator:   This form can be used when doing a home visit to evaluate a potential family for a rescued Airedale. Adoption or foster applicants you are visiting have already met preliminary criteria by having their Adoption Application accepted and have passed the telephone interview.

When doing a home visit, please attempt to get as much information as asked for on this form. Ask questions, where appropriate, and get as many details as you can about the home environment. Some of the questions on this form may not apply to a particular home so use your own judgment.

If possible, bring a friend or another rescue volunteer with you on the home visit. This helps both for the purpose of having another pair of eyes and ears to assist you in making a complete evaluation and for your own personal safety.

 

Name ____________________________________________________________

Address __________________________________________________________

City State ZIP ______________________________________________________

Phone ____________________________________________________________

Email _____________________________________________________________

Size of Home [estimate square footage if possible]:

 

 

Setting [check all that apply]:
£Rural
£ Semi rural
£ Suburban
£ Semi urban
£ Urban
£ Wooded
£ Open acreage
£ Waterfront
£ Highway frontage
£ Neighborhood street frontage
£City environment
£Property bordering on park/field

Condition of Home [check all that apply]:
Immaculate
Well-kept
Lived in but clean
Exterior untidy
Interior untidy
Exterior unkempt/poorly maintained
Interior trashed/dirty

 

Describe the home interior:
[Include type of furnishings, flooring, and general appearance. For example, “antiques with museum atmosphere,” “shabby furniture,” “brand new furniture and/or carpet,” “badly stained carpet,” “hardwood/ vinyl flooring with some carpet/rugs,” etc.]

Accommodations:
[Describe what accommodations the home has for a dog and where the dog will be left when the owners are not at home. For example, “crate in kitchen/laundry room,” “baby gate across kitchen,” “no crate planned,” “pen in basement,” “pen in garage,” “outdoor run,” etc. Include complete description of any pen or kennel [chain link run, dirt run with chicken wire, etc]. Will the dog ever be left chained out or left unattended in a fenced-in yard? Describe the fencing, if any, and consider security of fence.]

Children:

[Give ages of children, if any, and pay special attention to the behavior of the children, 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” for the care of the pets.]

Family Environment:
[Describe the behavior of the adults among themselves, and to any other pets or children. Are they respectful, hectic, noisy, loud, quiet, commanding, etc.?]

Life-Style Compromises:
[Has the applicant thought through life-style compromises pet ownership will require? Give details.]

Other Pets: 

[Describe number, type, age, and gender of the other pets and give complete description of their apparent health and well-being. Things to note would be skin or flea problems, condition of nails, overweight or underweight, type of collar, id tags other pets have, etc.]

Owner Interaction With Other Pets:

• Describe the relationship all family members seem to have to other pets.
• What role will the dog play in applicant’s life?
• Are the other pets treated like family members?
• How do the other animals behave?
• If applicant is looking for an additional dog, or cat why does applicant what another?
• Does applicant believe that the new dog will “train” old dog or vice versa?
• Has applicant ever owned more than one dog or cat at the same time?
• Is applicant prepared for the increased work, expense [including vet cost], and commotion?
• How committed is adopter?
• What are the owner’s responses to behaviors good and bad?
• Do owners demand perfection or have unreasonable expectation regarding behaviors?
• Do other dogs in the home obey happily?
• Are the other dogs out of control and undisciplined?
• Do the owners appear to know some basic training techniques?
• How do the animals react to the owner’s response?

 

Important Question to Answer:

• Explain that re-homing a dog is stressful for the dog.
• That often the rescued dog they want to adopt or foster may have training accidents, even if they are housebroken, while they are in their new home or foster care, for the first few weeks.
• Ask the applicant what they would do or how they would react to the new dog having an accident.

 

What was their reply?

 

 

 

 

Additional Information:

• Please describe any additional information 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 or cat in this home?
• If so, what?
• “Gut feelings” are considered important. Would you feel comfortable leaving your own dog with the applicant?
• Explain.

 

Conclusion:

Approve Applicant
Do not approve applicant
Approve after additional counseling of applicants
and/or
Approve after modifications to the home environment

Please describe:

Additional comments:

Home Evaluator’s Signature: ________________________________________

Date: _____________

Contact information: Email & Phone No.: ________________________________________

 

 

Additional Suggestions To The Home Evaluator:

• If you need to take notes during the visit, please do so discreetly on a small note pad, rather than on this form. It is preferred to have the applicants feel at ease with you and to be themselves. Complete this form after the visit is over, when you are not in the presence of the applicants.
• Qualities to note are sincerity, commitment, tolerance of normal animal behavior, honest representation of the home environment, children’s behavior with other pets, and expected role of the children in pet care. Obtain explanations about the absence of any family members during the visit. Feel free to ask leading questions to begin productive conversation. Often good conversation will reveal far more than questions.
• Do not make any promises to the applicants or indicate whether or not they will be approved to adopt or foster. Please refrain from discussing any particular animal presently in rescue that may become available for adoption.

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