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:__________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________   Condition of home:___________________________________________________________________ ____________________________________________________________________________________ ____________________________________________________________________________________ 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?______________________________ ________________________________________________________________________________ ________________________________________________________________________________ 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?__________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ _________________________________________________________________________________ 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:_____________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________