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INTAKE EVALUATION SHEET (DOGS)
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KENNEL #:DATE:
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AID:NAME:
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INTAKE TYPE:
Stray. Surrender. Adoption Return. Foster Return V/R. Confiscate
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AGE: ________________
WEIGHT: ______________
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ADMINISTERED/GIVEN
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Martingale
DHPP
INB
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Dewormer
Flea Tx
MC
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FAS SCALE SCORE
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LOW FAS:( 0 / 1 )Moderate FAS:( 2 / 3 )High FAS:( 4 / 5 )
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BEHAVIORSBODY LANGUAGE/COMMUNICATION
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Easy to leash up
Dog reactiveLoose bodyLip Licking
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Easy to kennel
Avoidant, fearfulTail wag_____________
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Door dartsSkittish, nervousCowering_____________
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Walks well on leash
Pot. to fear biteFlinching_____________
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Pulls on leash
Air snapsBarking_____________
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Stop/go on leash
Sensitive to touchPanting_____________
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Will not walk on leash
Sensitive to noiseHard stare_____________
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Leash reactive
Mounts peopleGrowling_____________
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PancakesConfident, relaxedStiff_____________
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Jumps up on people
Quiet, mellowWhale eye_____________
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Puts mouth on people
_____________Hackles raised_____________
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Barrier reactive
_____________Bared Teeth_____________
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Tolerant of handling
_____________Ears back_____________
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DOT COLOR PLACED
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In Chameleon
On Walker Board
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REASON FOR COLOR: ______________________________________________________________________
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COLOR CODING AT INTAKE
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1. Take weight & secure kennel as per usual
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2. Administer Vx, dewormer, flea treatment as per usual
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3. Fit martingale.
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4. Summarize your interaction with this dog in Chameleon as a BEHAVIOR note.
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5. Enter Tx administered or physical observations in this dog's MEDICAL records.
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6. Reference the Color Coding Guide to assign this dog a dot color based on their behavior.
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7. Enter the dot color in the HANDLING box on this dog's Chameleon kennel screen
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8. Print their CAGE CARD.
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9. Walk them to their kennel.
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10. Write their information and corresponding dot color on the WALKER BOARD.
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**If a dog is on a STRAY WAIT or other relevant HOLD, write their DUE OUT date on the walker board as well.
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