DOG ASSESSMENT FORM. In addition to completing the form from owner responses include your own observations wherever possible. Assessment.
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1 DOG ASSESSMENT FORM The owner is at all times responsible for their dogs behaviour. If at any time during the assessment you feel the dog is anxious or you feel unsafe then politely terminate the assessment. Do not put you, others or the dog at risk. In addition to completing the form from owner responses include your own observations wherever possible. Keepers Name Assessment Address address Telephone (Home) Telephone (Mobile) Dogs Name Dogs Details Breed (If a crossbreed and unknown parents please give best guess) Age & D.O.B Eye Colour Coat Colour Sex/Gender KC Details: KC Number KC Name Micro-chipped (Enter number if known)
2 Date of last vaccinations (Please check vet card) Neutered Yes / No Date of last season Date dog was last wormed Date dog was last flea treated How long have you kept this dog? Background Where did you get the dog from? Dogs background (How many homes/type of homes if known, including breeder). Include information such as kennel/farm/home bred/raised/behaviour of Dam etc Children (Including ages) Socialisation History (0-9 months) experiences with: Adults Other dogs (Type, circumstances etc ) Other animals (Species, circumstances etc ) Number of adults Current Home Number of children (Including ages) Other pets (Include species, breed, age etc ) How would you describe the household: Quiet Busy In between? Has the dog ever been kennelled? If yes please give details. What does the dog sleep in/on and in which rom? Does the dog choose to sleep there on its own accord?
3 Is the dog crate trained? Is the dog allowed on the furniture? Will the dog get off the furniture if asked? Describe the daily routine of the dog including meal times, times of walks, time alone etc. What type of environment is the dog used to being exercised in (fields, parks, urban areas etc. How long is the dog happy to be left alone for? Have you ever encountered any problems when the dog is left (toileting, destruction, barking etc. Has the dog ever been used as a guard dog? Has the dog shown any signs of aggression? (Resource guarding or other) Is the dog partially / totally house trained? What brand and type of food are they fed? How do they travel in a car? Observe and make notes of the following: How did the dog react to the assessors dog? Practical Assessment Initial response to arriving at the house Greeting behaviour
4 Behaviour throughout visit (how is the dog allowed to behave, owner interactions etc ) General demeanour (hostile, vocal, shy, over excited/boisterous, friendly but calm etc ) Handling Grooming of back, chest, stomach and around tail Owner to demonstrate ALL initially followed by the Assessor if safe to do so. Owner Assessor Open mouth, pick up paws, look in ears Restrain by collar Lean over/step over dog Hug the dog Ask owner to give a food treat (Note response) Owner to demonstrate how they play with their dog (Describe) What toys were used? (If applicable) During play describe any mouthing from dog, general control, and interest from dog Will dog play with the assessor?
5 Training: Owner to demonstrate what commands the dog knows (list commands, dogs response and method used if you can) Walking: Try to find out how the dog walks when out and about. (If you have time take a 10 minute walk around the block with dog and owner observing how easy it is to get the lead on, excitement level, any reactions to passers by etc ) Response to Recall command (Only in the home or in a fully enclosed space) Did the dog appear fit and healthy, clean and well groomed? Summary In the owners AND assessors opinion: What age children would you recommend this dog live with and why? Could the dog live with another dog? Could the dog be an only dog? Any other notes / observations (Please include anything you feel is relevant or of concern) OWNER UNDERSTANDS THAT THEY MUST SUPPLY A SUITABLE COLLAR/HARNESS AND LEAD Assessors name Please a scanned or photographed form to: heartwelfare@btinternet.com Please print and post a copy to the following address:- H-E-A-R-T Welfare 194 Bath Road Worcester WR5 3ER Contact no
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