LYR Home Inspection Checklist

Pre-Adoption Home Inspection Form

Lorain, OH 44053 Email:littleyorkierescue@yahoo.com

Website: littleyorkierescue.org

Note to home checker: Please read the Pet Adoption Agreement (link) first to ensure that you are aware of our Terms & Conditions for re-homing to be able to answer any questions. Please do not advise the prospective owner whether you have recommended them or not. Politely say that your job is to send the report to us and we will match the dog to the home if successful.

SECTION A – General Information

Name of LYR Rescue (s) you are Interested in:

Name

First NameLast Name

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Home Phone:

Phone Number

Area CodePhone Number

Email

example@example.com

Work Phone

Area CodePhone Number

Contact Phone

Area CodePhone Number

SECTION B – Neighborhood

Posted Speed Limit?

How would you describe your street?

Busy (near a major route, heavily traveled, or highway)Moderately busy/some traffic Quiet (mostly traveled by residents)Dead End Street or Cul de SacMostly Calm and Quiet (Not well traveled)Other

Describe the setting?

RualSuburbanUrban CityInner City / Neighborhood

Are there any city/town ordinances that the applicant is aware of in terms of the number of dogs

YesNoUnknown

Does the city/town have any breed ownership restrictions?

YesNoUnknown

Is the applicant familiar with the city/town's annual dog licensing requirements/fees?

YesNo

Is the applicant familiar with the city/town's annual dog licensing requirements/fees?

YesNo

Does the applicant agree to license their dog?

YesNo

Section Notes:

SECTION C – House & Yard

Housing situation? Check all that apply

Please describe your home. Is it a single family home (1 or 2 story), multi family home/apartment?

What floor do they live on?

If living in a condo or property with a Home Owners Association, are there any restrictions on dog ownership or Breed? (Explain)

Describe the # of pets allowed, weight, barking ordinance, or leash laws?

If renting, Landlord's name

Landlords Phone#

Does the home have central heat/air and adequate ventilation?

YesNoNot yet

If no central heat/air, what type of cooling/heating/ventilation systems are in place?

Describe the condition of the home. For example: is it neat, clean, and in good repair?

What is the number# of stairways inside and outside of the home? Please specify between inside or outside.

Are the pets secure in the home? (open/close doors, sliding glass doors left open, children running in and out of the home? )

Is there anywhere in the home or yard that the dog will not be allowed to go?

Is the yard fenced?

YesNoIf Yes Describe below

What type?

Chain linkPrivacyPicketOther

Is it adequately sized for the dog?

YesNoSomewhat

Is fence secure, free from holes, gaps, and weaknesses?

If No Did You . .

Discuss the importance of leash walks and exercise.Remind to never let dog have free roam outside.

Describe the enclosed patio or screened enclosure if any.

It there a Hot tub or Pool?

If yes to either, is there adequate protection from entry into the hot tub or pool?

YESNO

Please describe;

Is there any trash or chemicals in the yard that could harm a dog?

YesNo

Are there any areas in the yard where a dog could injure themselves?

YesNoMaybe

Is there a garage?

YesNo

If there is a garage, will the dog have access to it?

YesNoSometimes

Describe the condition; ( Is it clean, in good repair, and are hazardous substances out of reach of the dog?)

Section Notes;

SECTION D – Family & Other Pets

Does the family have children? If yes, how many and what are the ages?

YesNo

List: Name & Ages

If there are children, do the children seem like they would be respectful to pets?

YesNoSome but not All

Will the adults monitor the children's behavior with the dog?

YesNoPlan to

Are the children obedient and respectful towards their parents?

YesNoAt times

Children's Behavior: (respectful, hectic, loud, quiet, commanding etc.).

Please describe the behavior of the adults among themselves and towards any other pets.

Do they interact well with each other?

Do they express basic considerations and caring towards spouses, children, and other pets?

YesNoOther

Do the applicants have a basic understanding of the dog's needs and behaviors?

YesNoSomewhat

Does the entire family seem happy and committed to the idea of adopting a dog?

YesNoNot All

Notes

Does the family have other pets? If Yes, Please List. (Type: Name, Breed, Age)

List 1, 2 ,3 etc.

If ‘No’, skip to SECTION E - Plans for Adopted Dog

Are the pets get along well? Yes/No (List any concerns)

Are the pets cleaned and well groomed? Yes/ No (List an concerns)

Are the pets obedient and well trained? Yes / No (List any concerns)

Are the pets overweight?

YesNoSome areNo they underweight

Where do the pets sleep?

Are All pets current on vaccinations, including bordello? (Please Confirm)

YESNOSome not All

When are the next vaccinations due?

Is heart worm preventative and flea/tick preventative on hand? (Please Confirm)

YesNo

If SO, when is the next dose due?

What is the Brands of preventatives currently used?

If pet(s) are dogs, what Brand of dog food does the family use?

How often is the dog fed?

Are food/water bowls (inside and outside) clean and of adequate size?

Is the dog provided with toys, chews, treats, and beds?

May Little Yorkie Rescue contact your family VET?

YesNo

Name

Street Address Line

CityState / Province

Postal / Zip Code

Phone Number

Area CodePhone Number

SECTION E – Plans for Adopted Dog

Where will the adopted dog be kept during the day? (Check one)

Where will the adopted dog sleep? (Check one)

If crate is to be used, is it adequately sized and in good condition? Size:

Are there any questions or concerns about biting, house training, barking, or chewing?

How will they introduce the new dog to current pets?

Do they understand that sometimes rescue animals go through a period of adjustment?

How will they handle this and how long of an adjustment period do they think is reasonable?

Do they understand that rescue animals are not always the most reliable in terms of house breaking and that there may be accident for a few months? Yes / No List any concerns

How will they handle this?

Are there any special needs, circumstances, or concerns that we should consider?

Explain each of the following:

1. Inform family that adoption applications and pre-adoption home inspections are approved by Little Yorkie Rescue. LYR will contact the family regarding this inspection and the pending adoption. __

2. Recommend twice daily feedings. Remind the family that some rescue dogs may be a bit malnourished and will need to be fed more food, more often, and in some cases, higher calorie food such as puppy formula until sufficient weight is gained. __

3. Importance of bathing, nail trimming, ear cleaning. __

4. Importance of scheduling a vet visit within 7 days of the adoption. Little Yorkie Rescue will follow-up with the vet to be sure heart worm prevention has been purchased. __

5. Telephone Little Yorkie Rescue immediately if the adopted dog becomes lost or is stolen. __

6. Notify Little Yorkie Rescue at least one week prior to a change of address. __

7. Do not transfer the ownership of the adopted dog to any other person without first obtaining the adoption approval of Little Yorkie Rescue. The adopted yorkie may not be transferred to any other person, firm, corporation, or organization for any reason. __

8. If custody of the adopted dog must be relinquished, notify Little Yorkie Rescue immediately to arrange for its re-adoption. __

SECTION F – Your Assessment

As you are meeting the applicants and their pets, you can best determine what type of rescue will fit into their home and lifestyle. Would you be comfortable leaving your pet in the family's care? In other words, if you had to find a home for your own pets or needed someone to take are of them, would you feel confident leaving them in this home? Please be as specific as possible.

Do you think the applicant will provide a good, loving, and permanent home?

YesNo

Will they keep the dogs needs in mind?

YesNo

Will they provide a safe environment for the dog at all times?

YesNoTo some degree

Do you personally feel that the applicant should be approved or not approved?

Yes without a doubtNo

General Comments about your visit that will help determine if the applicant is a good fit>

Was there any Red Flags? Examples of red flags that might make you uncomfortable: Children hitting or mistreating the dog, Children not listening to the parents, Playing too roughly with the current dog, a family member seems uninterested or not in agreement with getting a new dog.

Signature of Volunteer/Home Checker:

Print Name

Signature*

Telephone:

E Mail:

example@example.com

REMEMBER: DO NOT TELL THE APPLICANT THAT THEY ARE APPROVED OR NOT APPROVED. LET THEM KNOW THAT YOU WILL BE TURNING IN THE HOME VISIT REPORT AND THEY WILL BE CONTACTED. **IF AT ANY POINT YOU HAVE A BAD FEELING OR ARE NOT COMFORTABLE WITH THE HOME, PLEASE SPEAK UP.**