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Home Safety Visit Report

Volunteer Information

Pulls from logged in, user’s profile
Volunteer Name
Address
MM slash DD slash YYYY
Did you read the Home Safety Visit Procedures prior to your visit?(Required)
Did you take the Home Safety Hazard Checklist to the visit to use as a guideline?(Required)

Applicant Information

Applicant Name(Required)
Address(Required)
Reason for Application(Required)

Household

Were all family members present?(Required)
How do they interact with each other? Do they express basic considerations and caring to their spouse, children, and other pets?
Were there any children in the household?(Required)
Do the children seem as if they would be respectful to pets? Will the adults monitor the children’s behavior with the dog? Do the children listen to the parents?
Do any members of the household have any special physical needs that we would need to consider?(Required)
Such as the use of a respirator, wheel chair, crutches, hard of hearing, blind where CPCRN should consider a dog with the capability to be a special needs dog
Are ALL members of the family are equally excited about getting a rescue dog?(Required)
Does the applicant appear to be willing and financially able to care for the dog in later years?(Required)

Neighborhood

Are there any dogs or other animals that live adjacent to this property?(Required)
Did you see any stray dogs or other animals in the immediate neighborhood during your visit?(Required)

Front Yard Fencing

Please select the type of FRONT yard that is at the home(Required)
Is there a lock on the gates of any of the fences?(Required)
Do you feel the fencing is able to properly contain a Cairn terrier without repairs or restructure?(Required)

Back Yard Fencing

Please select the type of BACK yard that is at the home(Required)
Is there a lock on the gates of any of the fences?(Required)
Do you feel the fencing is able to properly contain a Cairn terrier without repairs or restructure?(Required)

Understanding of CPCRN Policies on Fences and Leashes

Did you get the impression that the applicant uses “electric fencing” or tie-outs?(Required)
Did you get the impression that the applicant fully understands that Cairns can never be off leash?(Required)

Additional Home Information

Does the applicant have a swimming pool, fishpond, lake or other body of water on their property?(Required)
Will the dog have access to a garage or basement?(Required)
Do any members of the household have a hobby room or workshop? *(Required)

PREPARING FOR DOG'S ARRIVAL

Is there a crate available?(Required)
Did you make them aware that a crate is mandatory?
Is there a current dog?(Required)
Does the applicant have other pets (e.g. cats, rodents, fish, reptiles, birds)?(Required)
Are there dog toys available?(Required)
Do you feel they plan on getting toys?(Required)

REVIEW OF THE HAZARD CHECKLIST

Did you notice any hazards?(Required)

OTHER COMMENTS

Gut feelings often carry a lot of weight in our decision to place a dog with an applicant. Would you feel comfortable leaving your dog with the applicant and feel that the dog would be safe if you needed to?(Required)
This field is for validation purposes and should be left unchanged.

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  • Shop
  • Foster and Adoption
    • Adopt a Dog
    • Adoption FAQ
    • Fostering
    • Happy Endings
  • How to Help
    • Donate
    • Shop
    • Shop Our Affiliates
    • Fundraisers
    • Volunteer
    • Rescue Workers Forms
  • Forever Missed
    • The Rainbow Bridge
    • Memorials
    • Keepers of the Clan
    • CP Kids Memorial Garden
  • About
    • Who We Are
    • Our Team
      • Board of Directors
      • Officers
      • Special Thank You
      • Special Dedication
    • Acorn Awards
    • Special Events
    • Breed Information
      • AKC Information
      • Breed FAQ
      • Breeds We Work With
      • TOTO: The Other Side of the Story
      • The Disease Called Trust
    • Public Disclosure Tax Documents
  • Contact Us
    • Get in Touch
    • Col. Potter Tag Program
    • Rainbow Bridge Notification
    • Report a Terrier in Need
    • Release of Ownership
    • Newsletter Sign-up
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