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Home Inspection
General
Date of Home Inspection
(Required)
MM slash DD slash YYYY
Name of Home Inspection Rep
(Required)
First
Last
Applicant Name
(Required)
First
Last
Address of Home Inspection
(Required)
Street Address
Address Line 2
City
State
Alabama
Alaska
American Samoa
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Guam
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Northern Mariana Islands
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
U.S. Virgin Islands
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
State
ZIP Code
Home Inspection is for:
(Required)
Choose one
Foster applicant
Adoption applicant
Both
Neighborhood
Describe the Neighborhood
(Required)
Suburban
Urban/City
Rural/Farm
Would you describe this area as high traffic?
(Required)
No
Yes
Moderate
Is there a lot of human/dog foot traffic in the area?
(Required)
No
Yes
Moderate
Property has sidewalks or trails on one or more sides of the backyard
Is the neighborhood in what you would call a safe part of town?
(Required)
No
Yes
I'm not sure
The Home and Yard
Is the home:
(Required)
Single Family
Duplex
Condo
Apartment
Mobile Home
Camper/RV
Describe the interior of the home:
(Required)
Clean and free of clutter
Cluttered but clean
Unkept/Dirty with Clutter
Hoarder type conditions
Smells of cigarettes
Smells of animal urine or feces
Smells of marijuana
Notes/Comments
Is the yard:
(Required)
Fully fenced
Partially fenced
Shared/Community Dog Exercise Area
No Yard
No fencing - acreage
Underground/Electric fence
Livestock fencing
If fully fenced, please describe fencing:
(Required)
Secure
Some areas are not secure
Items piled up the dog could use to jump over the fence
5-6' Tall
3-4' Tall
Privacy fence
Split Rail fencing w/ chicken wire
Split Rail w/o chicken wire
Livestock fencing
Describe the appearance of the yard:
(Required)
Select all that apply
Clean, well kept
Could use a bit of work, but nice
Full of dog poop
Lots of yard debris (branches, weeds, etc)
Lots of clutter (kids toys, junk, etc)
Objects stacked or built near fence line
Notes/Comments
Where will the dog be kept when no one is home?
(Required)
Please be as specific as possible.
Where will the dog sleep?
(Required)
Please be as specific as possible.
Describe this type of foster home:
(Required)
Choose all that apply:
Foster dogs will be integrated with the family pets
Foster dogs will be kept in a room/private area within the home
Foster dogs will be kept in a pen/enclosure separate from the home
The Family & Resident Pets
Are there children in the home?
(Required)
Yes
No
Adult children live here
Sometimes - Shared custody
How did the children behave?
(Required)
Please consider their behavior towards you, their parents, the resident pets, etc.
Did you meet all the residents of the home?
(Required)
Yes
No
Was everyone open and willing to the idea of bringing in a dog(s)?
(Required)
Are there resident pets in/at the home?
(Required)
Dogs
Cats
Reptiles
Caged animals
Free Roam animals - ie rabbits, birds, etc.
Chickens/Poultry
Livestock
No resident pets
Sometimes dogs visit, but none are owned
Please list all cats/dogs in the home
(Required)
Species
Breed (guess)
Sex
Add
Remove
Did the family seem to have realistic expectations about bringing in a rescue dog?
(Required)
Yes
No
No, but we discussed it a lot and they do now
What are some discussed behaviors this family seems willing to handle?
House training
Crate training
Basic Obedience
Fleas, ticks, worms, etc.
Health needs
Anxiety
Fearful/Timid
Aggressive towards children
Aggressive to dogs
Not cat friendly
Barking
Would you leave your own dog here?
(Required)
Yes
No
It's a good home, but not for me
Please utilize this area to share any other concerns or notes.
Typing and signing my name below shall serve as my electronic signature.
(Required)
I hereby certify that I completed the home check outlined above and have answered these questions truthfully to the best of my ability.
First
Last
Signature
(Required)
Today's Date
(Required)
MM slash DD slash YYYY