Online Home Visit Evaluation Form

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Online Home Visit Evaluation Form

Home Visit Evaluation Form

Date: (*)	Please add a value for Date:.
Dog’s Name(s): (*)	Please add a value for Dog’s Name(s):.
Approve or Deny? (*)	Approve Deny Please add a value for Approve or Deny? .
Reason:

Name(s):
Street Address:
City, State and Zip:
Home Phone:
Cell Phone:

Is the home located on a busy street?	Yes No
Is there evidence of “dog-proofing” (i.e. valuables out of reach, dangerous plants, children’s toys, cat toys, small objects & electrical wires, contained garbage, secure doors/windows, etc.)	Yes No
If “no”, please explain:
Is there a “doggie door”?	Yes No
Where will the dog primarily be kept when people are home?	Kitchen Family Room Bedroom Garage Basement Yard Whole House Other?
If “other”, please explain:
Where will the dog sleep?	Kitchen Family Room Bedroom Garage Basement Kennel Other?
If “other”, please explain:

Is the yard completely fenced?	Yes No
If not, how will they provide a safe alternative?
What type of fence is it?
Height of Fence:	3 ft 4 ft 5 ft 6 ft
Are there potential escape routes? (holes in fence, loose gates)	Yes No
If "yes", please explain:
Any sharp objects that could injure the dog in the yard?	Yes No
If "yes", please explain:
If you noticed any problems, do you think they will fix the problems?	Yes No
Will the dog ever be kept on a chain?	Yes No
If so, how long?

Please list family members (Name, Relationship, Age):
Who will be the “primary” caregiver of the dog?
Do the children treat the pet respectfully?	Yes No
Do the children scream, hit or pull on the pet?	Yes No
Additional Comments:
Describe the behavior of the Children to other members of the household:	Respectful Hectic Loud Quiet Commanding Submissive Other
If “other”, please explain:
Do they plan on taking the new dog to obedience classes?	Yes No
How would they correct the new dog if it soiled on the carpet or chewed on valuable objects?

Does the family understand that rescues go through a period of adjustment that can last weeks or months and they may not see the dog’s “true personality” until then?	Yes No
Does the family have a basic understanding of a rescue dog’s needs, behaviors and possible fears of certain adults and children?	Yes No
Is the family prepared for accidents in or damage to the home during the adjustment period?	Yes No
Do they understand that dogs must ALWAYS be “monitored” when interacting with children, adults and with other dogs or cats, no matter how nice the dog?	Yes No

Do they seem like “animal people”, showing love & warmth towards current pets?	Yes No
Do you feel the adopter(s) will love and care for the dog properly?	Yes No
Do you feel this home will provide a permanent home for the dog?	Yes No
If this were your dog, would you do this adoption?	Yes No
Would you feel comfortable leaving your dog with this family?	Yes No
Does this adoption feel right?	Yes No
What are the overall strengths of the home?
What are the overall weaknesses of the home?
General observations?
Signature of CODAR Representative: (*)	Please add a value for Signature of CODAR Representative:.
Email Address of CODAR Representative: (*)	Please add a value for Email Address of CODAR Representative:.
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