OES HOME VISIT CHECK LIST

Name of representative conducting home visit:____________________________________

Representative’s phone number:___________________________________

Representative’s email address:____________________________________
 

The Family:

Name of family receiving home visit:____________________________________________

Address of family:_____________________________________________________________

Phone number:_______________________________________

Date of Home visit:____________________________________
 

The Home and Neighborhood:

Type of dwelling
_____Single family home   _____Townhouse
_____Condo     _____Trailer
_____Apartment    _____Multi family home

Applicants neighborhood:
Setting (check all that apply)
_____Rural     _____Wooded
_____Suburban    _____Waterfront
_____Urban     _____Neighborhood street frontage
_____Open acreage    _____Property bordering on park/field
_____Highway frontage
_____City environment

Describe the setting:__________________________________________________________________
_____________________________________________________________________________________
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Condition of home:___________________________________________________________________
____________________________________________________________________________________
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Does the home have a basement or garage:  Basement_____ garage_____ both_____

*****Make sure you go to the backyard*****

Does the applicant’s home have a fenced in yard?_________________________

Condition of fence and type of fence:____________________________________________________

Is the fence directly accessible from their home?_________________________________________

If no fencing, how/where do their dog(s) relieve themselves?______________________________
________________________________________________________________________________
________________________________________________________________________________

Will the dog ever be left chained out or left unattended in a yard?__________________________

Is there a dog house in the yard?_______________________________________________________
 

Experience with Dogs:

Does this family have a dog/dogs in their household?_____________________________________

How would the family handle a potty accident in the house?______________________________
________________________________________________________________________________
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How did they housetrain their own dogs?______________________________________________
________________________________________________________________________________
________________________________________________________________________________

What kind of feeding schedule would their be?_________________________________________

What brand dog food do they intend to feed the dog?____________________________________

Do they agree with crate training?_____________________________________________________

If yes, how long each day will the dog be in a crate?_____________________________________
 
 

If no, what are their feeling on this subject and what do they plan on doing with the
dog when they aren’t home?__________________________________________________________
_________________________________________________________________________________
_________________________________________________________________________________
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How did they react to the dog if it was along for this visit?_________________________________
__________________________________________________________________________________

Are there hazardous items around?_____________________________________________________

Are the children respectful of  pets?____________________________________________________

Are there any allergies in the family?__________________________________________________

Who will be the main caretaker?______________________________________________________

Conclusion

Does the family have a particular dog in mind for adopting:_______________________________

If yes, which one:_____________________________________________________________________

Why this dog?________________________________________________________________________

Do they understand the breed?_________________________________________________________

Why did this family decide to adopt a rescue dog?________________________________________
___________________________________________________________________________________

Did anything happen while you were at their home that cause you even a tad bit of
concern?    No_____  Yes_____

If yes, please explain:_________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________

Would you feel comfortable leaving your child or personal pet with this family? 
No_____  Yes_____

Expain:_____________________________________________________________________________
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