Home Visit - Foster and Adopter Applicants - TSCA Rescue & Health Trust

Tibetan Spaniel Rescue Home Visit Checklist

This form is used to conduct and document visits to homes of prospective adopters or fosterers.

The Home Visit Checklist comes in two versions - the online version below and a printable version (pdf) accessed from the Resources for Coordinators page.

The online version will be the official version that will be stored permanently with the applicant's Prospective Adopter Questionnaire or with the volunteer fosterer's Volunteer Application and Foster Home Questionnaire on Drive. If you are doing a virtual visit (via videochat) and you have two screens - one to view the home and the other to view the form (e.g., a laptop and a smartphone) - you can complete the online version while you are conductiing the visit. This is ideal since the built-in logic of the online form will ensure that you don't miss anything. However, if that's not possible, you can use the printable version while you are conducting the visit and then complete the online version after the fact.
The printable version is designed for taking notes by hand while you are conducting a visit. It follows the same order as the online form. Bear in mind that you may not always be able to conduct the visit in the same order as the form; you may need to jump around on the form. This may be easier on the printable version than the online version.

Before beginning the home visit, it is best practice to look up the home on realty sites and view any photos there. You may be able to find basic facts such as square footage and year built and get an idea of the general layout and appearance. Knowing this kind of info will facilitate the visit. You can pre-fill this info on the form before starting the visit (but do not submit the form).

When you must stop before completing the Checklist, scroll to the end where you will find a Save and Continue button. When you press the Save and Continue button, you will receive a link so that you can return to your Checklist later. You can also opt to have the link sent to you by email.

When you have finished answering all the questions, press the Submit button. If you missed a required question(s), you'll receive an error message. Scroll down through the form to find the errors in red. After correcting the errors, you must re-submit the form. If you made no errors, you'll see a confirmation message.

General Information

Region:(Required)

This is the region in which the home is located.

Northeast

Mid-Atlantic-Midwest

Southeast

Gulf South

North Central

Northwest

Southwest

Evaluator Name(s):(Required)

This is the name of the Coordinator or volunteer doing the visit and completing the form.

Type of Visit:(Required)

Adoptive Home

Foster-to Adopt

Foster

Is this visit related to a specific Tibbie available for adoption?(Required)

Yes

No specific Tibbie - foster volunteer visit

Tibbie's Name:(Required)

Applicant Name(s):(Required)

The "applicant" is the prospective adopter or fosterer whose home you are visiting.

Applicant Cell Phone:

Applicant Email:(Required)

Visit Date:(Required)

Time:(Required)

Mode of Visit:(Required)

Videochat

In Person

Home

These questions are about the home you are visiting.

Address:(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Type of Dwelling:(Required)

Single-Family

Townhouse/Row House

Apartment/Condo

Size of Dwelling:(Required)

Large (>2000 sq ft)

Medium (1000-2000 sq ft)

Small (<1000 sq ft)

Setting (check all that apply):(Required)

How far is the nearest emergency veterinary clinic?(Required)

Family and Pets

We generally begin the visit by meeting the family members and pets present.

Please list the names and ages of all persons who live in this home:(Required)

This should sync with the Questionnaire the applicant completed.

Did you meet all of the family members?(Required)

Yes, I met all the family members.

No, one or more family members were not present.

Which member(s) was not present? Why?(Required)

Who will be the Tibbie's main caregiver?(Required)

Does anyone have dog allergies?(Required)

Yes

Are children present?(Required)

Yes

Describe the children's behavior:

You may ask questions to elicit how they feel about a Tibbie coming to live with them.

Do pets live in the home?(Required)

Yes

List and describe the pets you met:(Required)

Include type (dog, cat, etc.), breed (dog), age, sex. This list should sync with the list on the Questionnaire.

Were there any pets you did not meet?(Required)

Yes, one or more pets were not present.

No, I met them all.

Which pets did you not meet? Why?(Required)

Did all the pets you met appear to be well cared for, clean and healthy?(Required)

Yes

Did all the pets appear to be well socialized and friendly?(Required)

Yes

Do you have any concerns about the pets' well-being?(Required)

Examples of concerns are "cage not clean," "reactive dog," "scratching-possible fleas."

Yes

Explain your concerns about the pets:(Required)

How do the family members and pets interact?(Required)

Interior of Home

You may need to skip around a bit in this section. After meeting the family and pets, we generally ask to begin by viewing the exterior doors to check for double barriers. However, while walking around, note other features such as staircases, types of flooring, where the dog eats and sleeps, and hazards.

Describe all exterior doors and type of barrier, if any:(Required)

Examples: Front door has a storm/security door, front door leads to a screened porch, slider leads to fenced yard, baby gate blocks access to front door.

Do all doors leading outside have a double barrier?(Required)

Yes

Are there staircases?(Required)

Yes

Describe all staircases:(Required)

Examples: Wooden treads with carpet runner, open with no risers, anti-slip strips on each tread

Is there a basement?(Required)

Yes

Would the Tibbie have access to basement?(Required)

Yes

Condition of the basement:(Required)

Is there a garage?(Required)

Yes

Would the Tibbie have access to garage?(Required)

Yes

Condition of the garage:(Required)

What types of flooring are there?(Required)

Examples: hardwood, vinyl, tile, carpet, throw rugs

Where would the Tibbie eat?(Required)

Describe the location and whether it is clean.

Where would the Tibbie sleep?(Required)

Describe the location and whether it is clean.

Would the Tibbie be allowed on furniture?(Required)

Yes

Would the Tibbie have free run of the house?(Required)

Yes

Where would the Tibbie typically spend the day?(Required)

Examples: gated into family room, free run of house

When the family is away from home, where would the Tibbie stay?(Required)

Examples: family room, crate in kitchen, laundry room, pen in basement, outdoor run

Is there a dog door?(Required)

Yes

Where does the dog door exit to?(Required)

Examples: from kitchen to gated deck, from mud room to fenced back yard, from garage to dog run

Can the dog door be closed?(Required)

Yes

Describe when the dog door is open and when closed:(Required)

If the door cannot be closed, enter N/A.

Are there any houseplants?(Required)

Yes

Describe type and location of plants:(Required)

Did you observe any of the following potential hazards at "Tibbie level":(Required)

Remember that Tibbies climb. Check all that apply.

Hanging electrical wires or cables

Small objects/choking hazards

Chemicals such as cleaning supplies

Human edibles such as candy

Trash

Other

None of the Above

Describe the hazard(s):(Required)

If it were necessary to quarantine the Tibbie for two weeks, where and how would the dog be kept separate?(Required)

If there are no other dogs, enter N/A.

Overall Impression of Interior:(Required)

Check all that apply.

Immaculate

Well-kept

"Lived In"/Clean

Messy

Trashed/Dirty

Poorly Maintained

Exterior of Home

When we have finished looking around inside, we generally go into the backyard or other area where the dog would potty and/or exercise.

Does a yard adjoin the home?(Required)

If there is no fenced back or front yard, we need to view where the dog would exercise and potty.

The home has a front yard and/or back yard.

The home has no yard but there is an off-street common area for use of the residents.

None of the above.

Describe the common area:(Required)

Since the home has neither a yard nor common area, describe where the dog would potty and exercise:(Required)

Is there a fenced area in which the Tibbie can go potty or exercise?(Required)

If the only fence is an electronic fence, check "No."

Yes

Roughly, how big is the fenced area?(Required)

Examples: 10'x20', 1/4 acre

Describe the fenced area:(Required)

Examples: grassy with some landscaping shrubs and a tree, sandy lot with no shade except under deck, pea gravel with some potted palms

Fence Standard

Inspect the entire fence-line with attention to each of these features:

The fence should be at least 4 feet high and have no gaps greater than 3” under the fencing, adjacent to gate posts or where the fence meets the house walls
There should be no gaps around gates and gates should latch securely, preferably with a lock.
Chain link should be “tight,” not sagging.
Pickets should be spaced no more than 3.75” - 4” apart, depending on size of Tibbie.

Describe the type of fence:(Required)

Include type of material (such as wood plank, chain link, vinyl picket), height, spacing between any pickets.

Do the gates latch securely?(Required)

Yes

Are there locks on the gates?(Required)

Yes

Walk the entire fenceline to inspect for escape points. Are there any gaps, holes or other defects that would allow a Tibbie to dig under, climb over or squeeze through the fence?(Required)

Yes

Describe the fence defects in detail:(Required)

These defects must be remedied before we can transfer the Tibbie into the applicant's care. Be specific.

Since there is no fenced area, describe where the Tibbie would potty and exercise:(Required)

Is anything pushed up against a fence or a rail which would allow the Tibbie to climb up and over the fence or rail?(Required)

Examples: outdoor furniture, garden equipment

Yes

Describe the climb/fall hazard:(Required)

Are there any water features within the area the Tibbie could access?(Required)

Pool

Pond

Other

None

Since you checked Other, describe the feature:(Required)

Is there any barrier to the feature?(Required)

Examples: pool fence, gate on deck

Are any predatory, poisonous or otherwise dangerous animals known to be in the area?(Required)

Examples: coyotes, birds of prey, venomous snakes, cane toads, dangerous stray dogs.

Yes

List dangerous animals in the area:(Required)

What measures would the applicant take to protect the Tibbie against dangerous animals?(Required)

Are any toxic landscaping plants accessible to the dog?(Required)

Examples: Sago palm, lily of the valley, rhododendron

Yes

Don't Know - recommend survey using toxic plant guide

Describe the plants:(Required)

Did you observe any of the following potential hazards in a location where the Tibbie could access them?(Required)

Remember that Tibbies climb. Check all that apply.

Hanging electrical wires or cables

Small objects/choking hazards

Chemicals such as pool supplies, automotive fluids

High places to leap from such as a deck or porch

Human edibles such as candy

Trash

Other

None of the Above

Describe the hazard(s):(Required)

Overall Impression of Exterior:(Required)

This pertains to whatever kind of exterior area the Tibbie would have access to, whether it's a fenced yard or other type of outside area. Check all that apply.

Immaculate

Well-kept

Messy

Trashed/Dirty

Poorly Maintained

Summary and Evaluation

The purpose of this section is to summarize your observations and document modifications and/or counseling needed.

Did you identify any interior hazards or escape routes?(Required)

Refer back to the Interior section.

Yes

Did you identify any exterior hazards or escape routes?(Required)

Refer back to the Exterior section.

Yes

Check all interior hazards that you have identified:(Required)

The Coordinator must discuss these concerns with the applicant.

Check all exterior hazards that you have identified:(Required)

The Coordinator must discuss these concerns with the applicant.

Does the home need modification?(Required)

Yes

Does the applicant need counseling about dog care?(Required)

Yes

List each modification (both interior and exterior) discussed:(Required)

Later on, we will use this list to verify that the modifications have been completed. Please be specific enough that someone other than yourself could do the verification.

List each topic on which the applicant was given or needs counseling:(Required)

Please be specific.

Overall, would the home environment - inside and outside - be Tibbie friendly once any modifications above are done?(Required)

Yes

Do you think the applicant will love and care for a Tibbie properly?(Required)

Yes

Would you feel comfortable placing a Tibbie here?(Required)

Yes

Use this space for any other comments about this home visit:

Home Visit – Foster and Adopter Applicants

Tibetan Spaniel Rescue Home Visit Checklist

General Information

Home

Family and Pets

Interior of Home

Exterior of Home

Fence Standard

Summary and Evaluation