Fostering Service
Pet Ownership Questionnaire
______
This questionnaire should be completed by the assessing worker at commencement of
Form F Assessment and at any time when a pet / new pet enters the household.
Staff should use this Questionnaire in conjunction with the Fostering Service ‘Dogs and
Pets Policy / Guidance’ and for applicants / foster carers with Dogs, BAAF Practice Note 42 ‘Placing Children with Dog Owning Families’. Staff with remaining serious concerns regarding dog temperament, management or potential risk can consider requiring the owner to evidence / reassure via a formal Vet’s check / reference (Appendix 1). Please discuss with your line manager if you feel presenting issues require this step.
If staff have any concerns arising from this questionnaire regarding advice for applicants on any issue of pet ownership or management, please discuss with your line Manager.
______
1) What type of pet do you own and how many do you keep?
Dogs [ ] Number [ ] Reptiles [ ] Number [ ]
Cats [ ] Number [ ] Insects [ ] Number [ ]
Small Mammals [ ] Number [ ] Birds [ ] Number [ ]
Fish [ ] Number [ ] Other ………………….
2) If a dog, please describe breed / type:
(breeds banned under current legislation: Pit Bull Terrier – Japanese Tosa – Dogo Argentines - Fila Brazillieros)
3) What size(s) are the pets that you keep? Please describe:
4) If appropriate for your pet, has it received any training? Yes [ ] No [ ]
(if yes, please describe and evidence any relevant training / certification etc)
1
5) Where in the household are the pets kept and allowed?
Kitchen [ ] Bedrooms [ ] Living Room [ ] Dining Room [ ] Outside [ ] Other ….....
Please provide some description of the living arrangements for your pet:
6) Are there areas outside the household that are exclusive to the pet(s) and if so where (eg secured compound / garden)? Please describe:
7) Where do the pet(s) normally sleep? Please describe:
at night:
during the day:
8) Where is the pet fed? Please describe:
9) If appropriate, where is the pet normally exercised and by whom? Please describe:
10) If appropriate to the pet,
(i) indicate temperament:
Boisterous [ ] Nervous [ ] Placid [ ] Docile / Submissive [ ] Playful [ ]
Protective of people [ ] Protective of household [ ] Possessive [ ]
(ii) please describe temperament indicated:
2
11) Where does the pet(s) toilet and how are responsibilities for health and hygiene in the household achieved? Please describe:
12) Has the pet(s) ever injured or hurt anyone? Yes [ ] No [ ]
If yes, please provide details and outline what treatment was needed:
13) Is the pet(s) registered with a vet? Yes [ ] No [ ] Not Appropriate [ ]
If yes, does it have required vaccinations / require treatment etc (eg worming; fleas) at regular intervals? (Please provide evidence of any vet records / pet registration etc)
Please give details:
14) If appropriate, what contact / experience has the pet(s) had of children staying in the household and for extended periods? Please describe:
15) How would you recognise and deal with any conflict between the pet and child / infant? Please describe:
16) Are you a breeder of any pets in the household? Yes [ ] No [ ] NB. If yes, please refer to the Fostering Service Dogs / Pets Policy (Section 8) and briefly describe here:
3
17) If you keep fish, please describe type and arrangements for how they are kept (including tank, where placed, how secured / covered etc)
18) Please include any other information you consider to be relevant here:
Name(s) of Applicant / Foster Carer:
Address: Postcode:
Signed: Date:
______
Assessing Social Worker / / Supervising Social Worker:
Signed: Date:
Revised April 2013 / SW 4
(Appendix 1)
Fostering Service
VET CHECK AND REFERENCE FORM FOR DOGS
This form should only be used if there are any remaining serious concerns regarding potential risk after completing the Pet Questionnaire with the applicant. The decision to utilise this form must be discussed and agreed with a line manager.
Date this Check / Reference undertaken: (use one form per dog)
______
Applicants complete this section:
Name of applicants:
Name of dog: Breed of dog:
Age of dog: Where did you purchase the dog?
______
Vet complete this section:
Are immunisations up to date? Yes [ ] No [ ]
If ‘No’ do you know why not?:
How did the dog present during the check? (Please tick):
Boisterous [ ] Nervous [ ] Placid [ ] Docile [ ] Playful [ ] Possessive [ ] Threatening [ ]
Comments:
From what you have seen today and the information you hold in your files is there anything that gives you cause for concern regarding this animal?
Yes [ ] No [ ] If Yes, please explain:
______
Veterinary Name / Practice stamp or details here:
______
Notes:
(i) Applicant/s need to provide the Vet with this form and then provide the completed form to the assessing worker / supervising social worker. The veterinary practice should retain a copy.
(ii) Invoices from Veterinary Practices should be forwarded to: The Administrator, Fostering Recruitment and Assessment Team, Leeds City Council, 8th Floor West, Merrion House , Leeds LS2 8DT