Animal Care and Holding/Boarding Survey

1. Facility Name _________________________________________________________

Address ________________________________________________________________

Number and Street City Zip

Facility Phone ( ) ______-____________ Fax ( ) ______-___________

 

2. Owner’s Name ________________________________________________________

Owners’ Home Phone ( ) _____-_________ Cell Phone ( ) _____-_________

Owner’s Pager ( ) _____-_________

 

3. What animal species will you accept?

‘Dog __ Cat __ Equine __ Livestock __ Avian __
Other ___________________________

 

4. Do you have a microchip scanner available?
No __ Yes__ Type:_______________________

 

5. How many cages, runs or stalls do you have available? Are any seasonal?

_____ Cages _____ Runs _____ Large Animal Stalls _____ Corrals

 

6. Would you be willing to provide services during a disaster?

‘Pro bono__ Reduced Rate ___________________
Standard rate __________________

 

7. What are the minimum entry requirements for animals to your facility?

None __ Rabies __ Other vaccinations __________________________________________

Parasite control  ___ Other ______________________________________________________

Would you waive them during a disaster? Yes __ No __

 

8. Does your facility have isolation facilities? Yes __ No __

 

9. Is your staff available outside normal hours of operation? Yes __ No __

 

10. Do you have a consulting veterinarian or vet clinic you work with? Yes __ No __

Name _________________________________________ Phone ( ) _____-___________

 

11. Give brief directions to your facility from the closest major road or highway. ______________________________________________________________________

______________________________________________________________________

 

Adapted from the Indiana State Annex for Veterinary Emergencies Committee.


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Draft On- line for
Nevada Animal Disaster Preparedness Guide

The draft was provided by the California Office of Emergency Services.
http://www.cdaf.ca.gov/programs/disasterprep.htm
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