To the BTBR Home Evaluator:
The adoption or foster applicants you're visiting have already met preliminary criteria by having their BTBR Application accepted. The information sought on this Home Visit form provides an even higher level of scrutiny .
When doing a home visit, please get the information sought 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 you need to take notes during the visit, please do so discreetly, 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 .
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. Ask open-ended questions to begin productive conversation. Open-ended questions include:
Rescue dogs are not always perfect; If you adopt a dog and it ends up having health issues, like blindness, deafness, seizures, etc., how will you handle that? If you adopt a dog and it marks in your home or shows signs of behavioral issues, how will you handle that?
Do not make any promises to the applicants or indicate whether they will be approved to adopt or foster.
First Name*
Last Name*
Email*
Name of Applicant: *
Cell phone number of Applicant:*
Date of Home Visit*
Is there an adult who will take responsibility for the BTBR dog?* Choose one: Yes No
Does the applicant appear physically or mentally impaired?* Choose one: Yes No
What are the gender/ages of each of the children in the household? Have the children spent time around dogs?*
Do the children seem to be treated well? Choose one: Yes No
Will there be any children visiting the applicant? How often? What are their ages? Do they have experience with dogs?*
Does/has applicant own(ed) a dog?* Choose one: Yes No
If Yes, describe number, type, age, and gender of the other pets:
Has applicant ever owned multiple pets at the same time?* Choose one: Yes No
If applicant is looking for an additional dog, why does applicant want another?
Do the current pets appear to be healthy, clean, well provided for, happy (skin or flea problems, condition of nails, overweight or underweight, type of collar, ID tags, etc.)? Choose one: Yes No
Does anyone in the family object to having a BTBR dog?* Choose one: Yes No
Is the home a/an: * Choose one: Apartment House Duplex Mobile Home Condominium / Townhouse
What is the location of applicant's home--urban, rural/farm, suburban, beach? *
Is the home close to or on a busy street or a street with a speed limit of 45 mph or more?* Choose one: Yes No
Is the home clean? * Choose one: Immaculate Well-kept Lived in but clean Exterior untidy Interior untidy Exterior unkempt / poorly maintained Interior trashed / dirty
Are there any potentially hazardous conditions, such as insect baits or poison, chemicals stored in open view, antifreeze in garage, poisonous plants (indoors or out), exposed wires or extension cords, etc.? Anything you find to be a potential hazard? * Choose one: Yes No
If so, please describe:
Will the BTBR dog be allowed on the furniture?* Choose one: Yes No
Where will the BTBR dog sleep at night?*
Will the BTBR dog have the run of the house?* Choose one: Yes No
Is there a doggie door?* Choose one: Yes No
If Yes, will the dog have access to the doggie door while no one is home or during the night? Choose one: Yes No
Is there a yard?* Choose one: Yes No
Is the yard clean and free of litter, poisonous plants, fertilizer, charcoal, charcoal lighter fluid, antifreeze, weed killer, broken glass and sharp objects? * Choose one: Yes No
Is the yard fenced? Choose one: Yes No
Is the fence built from: Choose one: Split Rail Chain Link Wood Cement Invisible Fence Wrought Iron - PLEASE advise the applicant that measures will be needed to safeguard the fence. Our usual recommendations are a heavy-gauge, small wire such as hardware cloth, to be attached securely to the wrought iron at a minimum height of FOUR feet. Other
Is the fence at least 4 feet high; is the fence free from gaps under the fence, between the pickets or between the house and fence? Choose one: Yes No
Are there any objects, firewood, piles of dirt, tool house, etc. next to the fence that a dog can jump on and from there, jump to the top of the fence? Choose one: Yes No
If the BTBR dog will be kept in outdoor run, describe in detail.
Will the dog ever be left chained or left unattended in a fenced-in yard? * Choose one: Yes No
How does the applicant plan to exercise the BTBR dog?*
Is there a pool, hot tub, pond, fountain, or other water venue?* Choose one: Yes No
Does the dog have direct access to the water venue, or is it separately fenced or protected in some way? Choose one: Yes No
If Yes, please describe in detail:
Is there a balcony on the property that the BTBR will have access to?* Choose one: Yes No
If Yes, could a dog jump over or squeeze through the balcony surround? Choose one: Yes No
Are there problematic dogs living nearby (aggressive. off-leash)?* Choose one: Yes No
Additional comments about applicants' home/yard?
Does the applicant work outside of the home?* Choose one: Yes No
Will the BTBR dog be left alone more than 6 hours per day?* Choose one: Yes No
Where will the BTBR dog be kept when nobody is home?* Choose one: No confinement planned Crate - dimensions (recommend using a large, sturdy wire cage if the dog will be left alone for multiple hours during the day - enough room for the dog to move around and also be able to see out) Baby gate Pen in Basement Garage Outdoor run (Include complete description of any pen or kennel - chain link run, dirt run with chicken wire, etc)
If Other, describe.
Does the applicant have experience with and understand the criticality of positive obedience training?* Choose one: Yes No
Do other dogs in the home obey readily? (Ask the applicant to tell their dog to sit). Choose one: Yes No
Does applicant have the time to train the BTBR dog, if necessary?* Choose one: Yes No
Is it understood that if approved to adopt a BTBR dog, adopters are responsible for picking the dog up from the foster parent?* Choose one: Yes No
Can applicant afford good quality dog food, dog biscuits, chew toys, beds, leashes, collars, etc.?* Choose one: Yes No
What type/brand of dog food is the applicant feeding their current dog or plan to feed the BTBR dog?*
Does applicant understand that routine vet care can cost several hundred dollars a year?* Choose one: Yes No
Does applicant understand the necessity for an annual heartworm test and to administer a regular heartworm preventative?* Choose one: Yes No
What brand of heartworm preventative does the applicant use for current pets or plan on using for BTBR dog?*
What products do you use/plan to use to treat flea/tick prevention in the BTBR dog?*
Will they keep the BTBR dog's vaccinations current and age appropriate for young and older dogs?* Choose one: Yes No
Is applicant willing to provide proper grooming (e.g. toenail clippings, ear and teeth cleanings etc.)?* Choose one: Yes No
Do applicants understand to never leave the BTBR dog in an unlocked car, never in a car during the summer, never with the dog's head out the window, never in the bed of a truck, never in the front seat?* Choose one: Yes No
Does applicant place dogs in a restraint in the back seat of their car? *
Are your current or have past pets been microchipped?*
Will the applicant ensure that the BTBR dog will ALWAYS wear an ID tag and replace if lost?* Choose one: Yes No
Rescue dogs are not perfect; how will applicant address adjustment or behavioral issues (aggression, elimination in home, hiding etc.)? *
Is applicant capable/experienced in dealing with dog health issues? Can applicant deliver an injection?*
Is there an interest in fostering-to-adopt?*
Recommendation regarding this applicant* Choose one: Approve - Excellent Approve - Above Average Approve - Average Reject - Below Average Reject - Disgraceful Reject - DO-NOT-ADOPT registry
Summary comments?
4/19/2023 1:58 PM
