Experimental Courtesy Visit Pilot

• Applicant name:

• Conducted on

  Date
• Location
  Address

• Prepared by

• Applicant Signature

  Sign

• Preparer Signature

  Sign

• 
  http://www.aphis.usda.gov/animal_welfare/downloads/Animal%20Care%20Blue%20Book%20-%202013%20-%20FINAL.pdf

Background and General Facility Questions

• Have you been licensed with USDA-APHIS-Animal Care before?

  Not Licensed

  Previously Licensed

• Can you tell me what happened to cause this failure to renew your license?

  Select didn't need a license until the Pet Rule Forgot to renew when it was time

  • didn't need a license until the Pet Rule
  • Forgot to renew when it was time

• Are you required to have a state issued license?

  N/A

  Required and applied for

  Current State/Local License

• Tell me about your past inspection reports – was anything cited, how were the problems fixed?

• Were there any minor issues or concerns that your inspector discussed with you previously but did not put on the report?

  Yes

  No

  N/A

• What measures have you taken to fix those issues/concerns?

• Do you understand that there are no “teachable moments” or “minor issues” for these prelicense inspections?

  Yes

  No

  N/A

• What type of breeding dogs you mostly raise?

  Select Large Breed Medium sized Small Breed

  • Large Breed
  • Medium sized
  • Small Breed

• How many breeding animals do you currently have?

• Are these all of the animals and locations you are using or intending to use for regulated purposes?

  Yes

  No

  N/A

• Have you ever pled ‘no contest’ or have you ever been found to have violated any Federal, State, or local laws or regulations pertaining to animals?

  Yes

  No

  N/A

• Would you please explain the circumstances around your plea?

Animals Raised/Kept Inside the Home or Animals Cohabitating with Humans

• Do you keep or raise animals in your home?

  No

  Yes

• Are these animals limited to a specific area of the home or do they have unlimited access? Or are placed in a room that is set aside specifically for the animals’ – whelping room, nighttime sleeping room, etc.?

  Limited Access

  Unlimited Access

  Specific Area

• Tell me about any enclosures you may use for the animals – (e.g. “vari kennels”, playpens, stack caging).

• Are they large enough to meet the floor space requirements of a primary enclosure?

  Yes

  No

  N/A

• If you do – do you understand that this animal area will need to meet the requirements of indoor housing including surfaces, ventilation, etc.? (need to refer to Indoor housing facility questions at this point)

  Yes

  No

  N/A

• Do you understand that we will need to inspect all areas housing animals and items associated with their care?

  Yes

  No

  N/A

• Do you understand that the areas of the home that are available to the animals must be kept clean and safe to ensure their well- being? (Safety hazards – electrical cords, toxic plants, choking hazards, etc.)

  Yes

  No

  N/A

Indoor Facilities (not applicable to animals cohabitating with humans): Indoor housing facility means any structure or building with environmental controls.

• How is the facility heated and cooled and how is the temperature regulated?

  Select Gas Electric Hot water No Supplemental

  • Gas
  • Electric
  • Hot water
  • No Supplemental

• What is the average temperature inside the facility?

• Tell me how you monitor the temperature and humidity levels?

  Select Thermostat Thermometer Nothing at this time

  • Thermostat
  • Thermometer
  • Nothing at this time

• How is it ventilated?

  Select Air Conditioning Doors/Vents Windows/Vents Auxiliary Ventilation

  • Air Conditioning
  • Doors/Vents
  • Windows/Vents
  • Auxiliary Ventilation

• How is the facility lighted?

• What is the lighting schedule?

• Are interior surfaces including walls, floors, and ceilings impervious to moisture?

  Yes

  No

  N/A

• What is used to make the surfaces impervious ?

  Select Impervious Materials Water Proofing Sealents Paint Not Impervious

  • Impervious Materials
  • Water Proofing Sealents
  • Paint
  • Not Impervious

• How often are surfaces replaced or repaired? (this applies to indoor kennels or indoor animal rooms – not interior of houses where humans and animals cohabitate)

  As needed

  On a scheduled basis

  No maintenance plan

• Which kinds of enclosures are present and what sizes do you use?

Outdoor Facilities

• Have you discussed the following issues with your attending veterinarian?

  Yes

  No

  N/A

• Housing dogs (and cats) outside that are not acclimated to the temperatures common in your area; breeds of dogs (and cats) that cannot tolerate common seasonal temperature variations in your area; sick, infirm, old, and young dogs (and cats)?

• Have you received written approval from your attending veterinarian to do so?

  Yes

  No

  N/A

• Do your enclosures provide shelter from the heat and cold?

  Yes

  No

  N/A

• Is there protection from direct sunlight, rain, wind, and snow?

  Yes

  No

  N/A

• Are there wind and rain breaks at the entrance of shelter structures?

  Yes

  No

  N/A

• When do you provide clean and dry bedding for the shelter structures?

• What is the bedding and how often is it replaced or refreshed?

• Are surfaces in contact with the dogs (and cats) impervious to moisture?

  Yes

  No

  N/A

• What is used to make the surfaces impervious ?

  Select Impervious Materials Water Proofing Sealents Paint Not Impervious

  • Impervious Materials
  • Water Proofing Sealents
  • Paint
  • Not Impervious

• How often are surfaces replaced or repaired?

• Do you use metal barrels, cars, refrigerators or the like as shelter?

  Yes

  No

  N/A

Sheltered Facilities

• How is the facility heated and cooled and how is the temperature regulated?

  Select Gas Electric Hot water No Supplemental

  • Gas
  • Electric
  • Hot water
  • No Supplemental

• What is the average temperature inside the facility?

• Tell me how you monitor the temperature and humidity levels?

  Select Thermostat Thermometer Nothing at this time

  • Thermostat
  • Thermometer
  • Nothing at this time

• How is it ventilated?

  Select Air Conditioning Doors/Vents Windows/Vents Auxiliary Ventilation

  • Air Conditioning
  • Doors/Vents
  • Windows/Vents
  • Auxiliary Ventilation

• Do your enclosures provide shelter from the heat and cold?

  Yes

  No

  N/A

• How is the inside facility lighted?

• Are surfaces in contact with the dogs (and cats) impervious to moisture?

  Yes

  No

  N/A

• What is used to make the surfaces impervious ?

  Select Impervious Materials Water Proofing Sealents Paint Not Impervious

  • Impervious Materials
  • Water Proofing Sealents
  • Paint
  • Not Impervious

• Which kinds of enclosures are present and what sizes do you use?

Veterinary and Health Issues

• Who is your AV?

• Has your attending veterinarian visited recently?

  Yes

  No

  N/A

• What is your formal arrangement?

• When was their last visit?

  Date

• How have you given your AV appropriate authority to ensure that adequate care is provided to your animals?

  Yes

  No

  N/A

• Do you have a current, written program of veterinary care (PVC) signed by your AV?

  Yes

  No

  N/A

• The APHIS 7002

• Does the written PVC reflect what you actually do at your facility?

  Yes

  No

  N/A

• Does the PVC cover routine medications, vaccinations, routine treatments including routine dental care, and when needed, euthanasia?

  Yes

  No

  N/A

• Do you have any expired or unlabeled medications?

  Yes

  No

  N/A

• How often do you observe each animal and what do you do when problems are discovered?

  Daily

  Twice Daily

  Every other day

• How are problems recorded and communicated to your AV?

• Do you maintain medical records?

  Yes

  No

  N/A

• Do you have a plan for nail and hair coat maintenance; eye, ear, and dental care; and flea and tick prevention?

  Yes

  No

  N/A

• Nails

  

• Dogs Teeth

  

• Matted Hair

  

Exercise program for the dogs

• How is it scheduled and how is it documented?

• Do you have a play yard or exercise area that is securely fenced?

  Yes

  No

  N/A

• Is it free of debris, weeds, and dangerous objects?

  Yes

  No

  N/A

• Do you have this exercise plan written down?

  Yes

  No

  N/A

• Has your AV signed off on this plan?

  Yes

  No

  N/A

Identification and Records

• How are dogs/puppies (and cats/kittens) identified?

  Select Micro Chipping ID Tags Tattos No ID Meathod

  • Micro Chipping
  • ID Tags
  • Tattos
  • No ID Meathod

• Do you have a microchip scanner if you plan on using microchips?

  Yes

  No

  N/A

• Are you familiar with APHIS Form 7005(Record of Acquisition of Dogs and Cats on Hand)?

  Yes

  No

  N/A

• 
  http://www.aphis.usda.gov/library/forms/pdf/aph7005.pdf

• Have you recorded the dogs’ (and cats’) ID number, gender, breed, physical description, date of birth, and acquisition date on this form?

  Yes

  No

  N/A

• Do you have all the acquisition information possible (name, address, USDA license number, driver’s license number, etc.)?

  Yes

  No

  N/A

• Are you familiar with APHIS Form 7006(Record of Disposition of Dogs and Cats)?

  Yes

  No

  N/A

• 
  http://www.aphis.usda.gov/animal_welfare/downloads/forms/aph7006.pdf

Additional Topics for Cat Facilities

• Describe your housing for the adults cats – are you using individual enclosures or colony housing?

• What type of queening enclosures and boxes are you using?

• What size enclosures are you using for adults and for queens and kittens?

• What is the height of the enclosures?

• What type of litter and litter pans are you using?

• Describe the resting surfaces in the enclosures – how many are in each enclosure and what height are they?

Additional Topics

• How do you manage pest control?

• How is waste fluid drained?

• How is food stored in the kennel?

• How are extra bags of food and extra bedding material stored?

• Who will be caring for the animals, apart from you?

• Have they had training in the care and husbandry of the animals and are they familiar with:

  Select The Program of Veterinary Care The Exercise Plan The Maintenance Plan any other procedures you have in place to ensure compliance

  • The Program of Veterinary Care
  • The Exercise Plan
  • The Maintenance Plan
  • any other procedures you have in place to ensure compliance

• How is housekeeping maintained?

• Describe your routine maintenance plan?

• Are there days and/or times during the week when you are unavailable for routine inspections?

  Select monday mornings monday afternoon tuesday morning tuesday afternoon wednesday morning wednesday afternoon thursday morning thursday afternoon friday morning friday afternoon

  • monday mornings
  • monday afternoon
  • tuesday morning
  • tuesday afternoon
  • wednesday morning
  • wednesday afternoon
  • thursday morning
  • thursday afternoon
  • friday morning
  • friday afternoon

• Is there someone else who you can authorize to be available for routine inspections?

• Are you licensed with the State?

  Yes

  No

  N/A

• If so, for how many years?

• When was your last inspection?

• Were any issues identified?

  Yes

  No

  N/A

• Have they been corrected?

  Yes

  No

  N/A

• Do you understand the difference between regulated and unregulated activity?

  Yes

  No

  N/A

• Do you understand that you cannot conduct regulated activity until you have a USDA license?

  Yes

  No

  N/A

• Do you have your copy of the Animal Welfare Act (“the blue book” or the CD)?

  Yes

  No

  N/A

• Have you read through the regulations and standards that apply to your facility and to your situation?

  Yes

  No

  N/A

• Do you understand that you are legally responsible for complying with all of them?

  Yes

  No

  N/A

• Are you aware that once the first pre-license inspection is conducted, you have 90 days to complete the inspection process with a maximum of three inspections?<br><br>Note: It can take a week or two to schedule second and third inspection so please allow for that time to schedule inspections.

  Yes

  No

  N/A

• When the first pre-license inspection is conducted (please allow at least 2-4 hours), we will first be reviewing some educational components and tools. Once that is completed, we will be doing the physical inspection. Do you understand this can take a few hours?

  Yes

  No

  N/A

• Do you feel that you are ready for an inspection?

  Yes

  No

  N/A

• Do you understand that 100% compliance is required to pass and receive a license?

  Yes

  No

  N/A