Animal Welfare Assessment Questionnaire Form
Complete this form to assess animal welfare conditions and record observations, ratings, and recommended follow-up. Use the exact title consistently across the form.
General Assessment Information
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor Name
*
Organization or Facility Name
*
Location / Address of Animal Setting
*
Animal Type / Species
*
Please Select
Dog
Cat
Horse
Cattle
Sheep
Goat
Pig
Poultry
Rabbit
Other
Animal Welfare Evaluation
Overall Welfare Rating
*
Very Poor
1
2
3
4
5
6
7
8
9
Excellent
10
1 is Very Poor, 10 is Excellent
Welfare Criteria Evaluation
*
Rows
Poor
Fair
Good
Excellent
Food and water availability
1
2
3
4
Shelter and cleanliness
5
6
7
8
Space and movement
9
10
11
12
Behavior and handling
13
14
15
16
Apparent health and condition
17
18
19
20
Priority Concern or Notable Issue
Recommendations and Outcome
Recommended Next Steps / Actions Required
*
Final Assessment Status
*
Satisfactory
Needs Improvement
Urgent Follow-up
Other
Submit Form
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