Hooks Home Bound Rescue Applications
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Foster Home/ Adoption Home Inspection Re-Inspection Sheet
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APPLICANT/PROVIDER NAME
APPLICANT ADDRESS include city state zip
TELEPHONE NUMBER
INSPECTION DATE
HOME VISIT VOLUNTEER’S NAME:
ORGANIZATION AFFILIATION
VOLUNTEER’S ADDRESS:
VOLUNTEER’S PHONE:
VOLUNTEER’S EMAIL ADDRESS
APPLICANT INTERESTED IN FOSTERING/ADOPTING (NAME OF DOG):
TIME AND DATE OF FIRST VISIT:
Statement of Facts:
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I agree I have the authorization from the requested adopter/foster and Owner of Hooks Home Bound Rescue to perform this Home check and Interview.
YES
NO
I also agree that in performing this home check and interview that I will not disclose the results of this interview or home check with anyone unless authorized to do so by Hooks Home Bound Rescue and/or The requested Foster/Adopter.
YES
NO
I also agree that all information received from this home check and interview will be kept confidential, and private.
YES
NO
I will contact the proper authorities if in any case of this home check/ interview there seems to be a life threatening emergency to either the adopter/foster or animals in the home.
YES
NO
I agree to perform this interview professionally and accurately! I also agree if I am to falsify any information on this form I may be prosecuted for falsifying information!
YES
NO
GENERAL HOME AND AREA:
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Type of neighborhood:
Urban
Suburban
Rural
Type of home:
Single-Family
Apartment
Mobile
OTHER
Does applicant:
Own
Rent
If renting, does applicant’s landlord approve of pets
YES
NO
Type of street:
Busy/Dangerous
Quiet
In-Between
Country Road
Does the exterior of the home look well-cared-for in appearance
YES
NO
Are there any dogs in adjacent homes or yards
YES
NO
Are there many children in the neighborhood
YES
NO
Pets running loose
YES
NO
Any dog walking parks/beaches in the area? HOW FAR?
NOTES/COMMENTS
Is there a yard
YES
NO
Is the yard:
Fully Fenced
Back Yard Fenced Only
Side Yard Fenced only
Not Fenced
Holes or gaps in fence
YES
NO
Are the gates secure
YES
NO
Is the yard reasonably free of feces, trash, construction material, car parts/fluids or other items that might presenthealth problems for a pet
YES
NO
Is there a pool
In-ground
Above-ground
None
Other Pet
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Does the applicant have any other pets
NO
DOGS
CATS
BOTH DOGS AND CATS
OTHER
Where are they housed
Are all animal up to date on vacinations
yes
no
Are all dogs/cats spayed or neutered?
yes
no
notes/comments
Building and Structure:
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Does home have insurance? Either renters / homeowners
yes
no
Is there a dog house or other outside shelter
yes
no
Doggie door
yes
no
Crate inside home
yes
no
Overall condition of the interior of home
Neat/clean in excellent repair
Messy in good repair
Dirty in need of major repair
Address and signage is clearly visible and location is accessible
yes
no
Premises are free from pests.
yes
no
Cleaning supplies, toxic substances, etc. are inaccessible
yes
no
Floors are washable.
yes
no
Home has at least one working telephone for emergencie
yes
no
Light fixtures provide proper visibility and comfort
yes
no
Room temperatures are at reasonable levels
yes
no
Home has adequate ventilation
yes
no
Foster/Adopter parent will ensure water temperature does not exceed 110 degrees or fall below 38 degrees
yes
no
Sewage/Water is from/discharged to public system orapproved private supply
yes
no
Locks on outside exit doors can not be unlocked by dogs
yes
no
Flammable materials and poisons are inaccessible to dogs.
yes
no
Rooms have adequate floor space for safety and comfort and appropriate furnishing for pets
Knowledge
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Do you get the impression the applicant understands that the dogMUST be leash-walked and supervised when allowed outside fenced yard
yes
no
Supervision plan is in place if hazardous conditions exist
yes
no
Is the family aware of possible shedding
yes
no
Family and Household
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Did you meet all family members
yes
no
Are there any concerns for young children, elderly, or disabled?
yes
no
Obstacles are not placed in exit ways, stairways, or rescue windows.
yes
no
Does Family have a plan for obtaining proper restraints for dog as needed
yes
no
Smoke alarms are in good working condition and are mounted correctly
yes
no
Home has at least one working 2A10BC-rated 5lb. or larger ABC fire extinguisher
yes
no
All First aid supplies and medication are on hand and stored properly
Will dog present a problem with environment/allergies
yes
no
Does family have an evacuation plan that includes pets in case of emergency
yes
no
Where will the dog spend most of its time
Does the area appear suitable
yes
no
Where will the dog stay when no one is at home
If applicant has a crate for dog they are adopting, is the size appropriate for the dog
yes
no
Are they willing to give the new dog several weeks to acclimate to their environment
yes
no
Describe any concerns for the animal's safety and happiness if placed in this environment
Did you get the impression that anyone in the family is opposed to adopting this pet, please explain?
How do children in family behave towards other family members and pets?
What is the applicant's opinions/experience with crating?
Where will the animal sleep?
How do they interact with their current dog/cat/other pet(s)?
Where will the animal eat/drink?
Does the applicant or family members have any special needs or challenges?
What is the applicant's animal training experience?
How would they correct misbehavior?
Does the age/sex/type of dog requested appear to 'fit' for the family and home?
Were there any training or behavior questions that you couldn't answer which need a follow up?
Were there any questions about the Hooks Home bound Rescue’s Adoption/Foster Requirements that you couldn't answer which would need a follow up?
Would you, personally, recommend that Hooks Home bound Rescue place a dog in this home?
Use additional space to describe your visit and note any other items, areas that need education, fence needing repairs, or other concerns:
Are you (the volunteer) available to do a follow-up visit if necessary
yes
no
Please thank the person you are interviewing and advise them Hooks Home Bound Rescue will get back to them when inspection is processed! We here at Hooks Home Bound Rescue wish to thank you for your time in processing this application, Home Check and Interview! We are looking forward to the placement of this animal into the forever Respectful Home!
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