Animal Shelter Agent/foster Home - Inspection Report
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1ANIMAL SHELTER AGENT/FOSTER HOME - INSPECTION REPORT
GEORGIA DEPARTMENT OF AGRICULTURE [HEREINAFTER “GDA”]
“PET” IS USED AS DEFINED IN THE “RULES OF GDA 40-13-13-.01”
“ANIMAL SHELTER AGENT” IS USED AS STATED IN THE “RULES OF GDA 40-13-13-.02(6)”
GDA LICENSED Humane Society ____Douglas County Humane Society____ GDA LICENSE # ___A04-0275____
PLEASE PRINT THE FOLLOWING ANIMAL SHELTER AGENT/FOSTER HOME INFORMATION:
NAME _____________________________________________________________________________________________________ PHONE # ________________________________________
PHYSICAL ADDRESS ______________________________________________________________________________________ COUNTY ________________________________________
CITY _________________________________________________________________________ STATE _______________________________ ZIP CODE ______________________________
PLEASE CHECK ONE OR MORE: [INDOOR PET HOUSING ________] [OUTDOOR PET HOUSING ________] [PET TRANSPORTER - VEHICLE _______]
(1) THE PERSON(S) AUTHORIZED TO PERFORM ANIMAL SHELTER AGENT/FOSTER HOME INSPECTIONS MUST BE LISTED
ON THE ANIMAL SHELTERS GDA LICENSE APPLICATION IN EITHER THE LICENSE HOLDER SECTION OR SECTION #4; (2)
ANY CATEGORY MARKED FAIL MUST BE CORRECTED IMMEDIATELY AND RE-INSPECTED WITHIN SEVEN DAYS. THREE
CONSECUTIVE FAILURES IN THE SAME CATEGORY WILL DISQUALIFY THE ANIMAL SHELTER AGENT.
(1) THE FOLLOWING CATEGORIES ARE FOUND IN THE “RULES OF GDA CHAPTER 40-13-13 ANIMAL PROTECTION”;
(2) IF A CATEGORY IS NOT MARKED PASS OR FAIL, AN EXPLANATION MUST BE GIVEN ON THE ADJACENT LINE BELOW; AN
ADDITIONAL SHEET MAY BE ATTACHED FOR FURTHER EXPLANATION:
PASS – FAIL
(1) ADEQUATE FOOD 40-13-13-.01
[
] - [
] ______________________________________________________________________________________
(2) ADEQUATE WATER 40-13-13-.01
[
] - [
] ______________________________________________________________________________________
(3) ADEQUATE TEMP. CONTROL 40-13-13-.01
[
] - [
] ______________________________________________________________________________________
(4) ADEQUATE VENTILATION 40-13-13-.01
[
] - [
] ______________________________________________________________________________________
(5) PROPER ANIMAL HEALTH CARE 40-13-13-.01 [
] - [
] _______________________________________________________________________________________
(6) CLASSIFICATION & SEPARATION 40-13-13-.04 [
] - [
] ______________________________________________________________________________________
(7) HOUSEKEEPING 40-13-13-.04
[
] - [
] ______________________________________________________________________________________
(8) PEST CONTROL 40-13-13-.04
[
] - [
] ______________________________________________________________________________________
(9) SANITATION 40-13-13-.04
[
] - [
] ______________________________________________________________________________________
(10) SHELTER 40-13-13-.04
[
] - [
] ________________________________________________________________________________________
(11) SPACE REQUIREMENT 40-13-13-.04
[
] - [
] ______________________________________________________________________________________
(12) STRUCTURAL STRENGTH 40-13-13-.04
[
] - [
] ______________________________________________________________________________________
(13) WASTE DISPOSAL 40-13-13-.04
[
] - [
]
INSPECTED BY (SIGNATURE) ____________________________________________________________ (PRINT) ________________________________________________________
ANIMAL SHELTER AGENT/FOSTER HOME (SIGNATURE) ______________________________________________________________________________________________
DATE ____________________________________________________________
(1) THIS REPORT MUST BE ON FILE AT THE ABOVE GDA LICENSED ANIMAL SHELTER; (2) A COPY MUST BE ON FILE WITH THE ANIMAL
SHELTER AGENT/FOSTER HOME.
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