ITD, Inc. Evaluation

Therapy Dog Evaluation Independent Therapy Dogs, Inc.

NOTE: Dog must test on flat buckle collar and 4 foot leash. Training collars/devices are not allowed for evaluations.

Owner/Handler Name__________________________________________________________________________________ Phone(s) ___________________________________________________

Address, City, State, Zip ________________________________________________________________________________ Eddress ____________________________________________________

Dog’s Name ________________________________________ Breed __________________________________________ Dog’s Age ___________________________________________________

Why do you want to do therapy dog visiting? _______________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________________________________

Have you ever done therapy dog visiting? _____________________________________________ Therapy Program (name) _________________________________________________

Canine Good Citizen Certification date _________________________________________ Proof provided ___________________________________________________________

P- F Evaluation Criteria Comments

 Accept a friendly stranger: Demonstrates dog will allow friendly stranger to approach it; speak in a natural everyday

situation. Dog shows no sign of resentment or shyness; must not break position or try to go to handler on approach. __________________________________

 Sit politely for petting: Dog allows friendly stranger to touch it while w/ handler. Dog shows no shyness or resentment

when petted on its head and body. __________________________________

 Allows evaluator to stroke the head and body tail with both hands. __________________________________

Allows evaluator to apply the following actions:

 Pull ears and put fingers in ears  Touch and press paws/nails, press body  Scratch/pet dog’s throat

Check teeth for cleanliness  Pull tail __________________________________

Allows evaluator to hug around dog’s neck and body?  1 person Group of people __________________________________

Does the evaluator observe any of the following:  Excessive sniffing Barking Excessive licking __________________________________

 Walk on loose lead: Dog leaves no doubt that it is attentive to the handler and is responding to the handler’s

movements and change of direction. Demonstrates handler is in control of the dog. __________________________________

 Walking the Crowd: Dog moves politely through pedestrian traffic; is under control in public. Dog continues to walk past several

people with little interest; without over-exuberance, shyness, resentment. Dog does not jump on people; strain the leash. _________________________________

 Dog allows multiple people at once to crowd and pet. __________________________________

 Dog does not attempt to jump on people. __________________________________

 Dog does not overreact to being bumped from behind:

 Sit and down on command: Dog must sit AND down on command. With long leash dog must stay and remain until

evaluator instructs the handler to release the dog. __________________________________

 Recall/coming when called: Dog comes immediately when called. __________________________________

 Reaction to another dog: Dog behaves politely around other dogs. Two handlers and their dogs approach dog and dog

should show no more than casual interest in other dog. Neither dog should go to the other dog or its handler. __________________________________

 Reaction to distraction: Dog remains confident when faced with common distracting situations. Evaluator presents two. Dog may

express natural interest or may appear slightly startled but should not panic, try to run away, show aggressiveness, or bark. _______________________________

Does evaluator observe fear or excessive reaction to the following:

 Doorways enter/exit  Sudden loud noise/overhead pager/Cell phone/alarm Wheelchair/walker/cane/crutches  Stairs up/down  Elevator

 Children  Surface textures: grass, cement, wood __________________________________

 “LEAVE IT” Dog follows command to “Leave it”? (food and toy) __________________________________

Overall Evaluation and Conclusion

Dog demonstrates willingness to participate in evaluation: ______________________________________________________________________________________________________

Dog demonstrates ability to calm down and respond if excited: _________________________________________________________________________________________________

Did dog become unresponsive to commands during evaluation: _________________________________________________________________________________________________

Did dog make any attempt to mark territory: ______________________________________________________________________________________________________________________

Was handler in control of dog at all times: __________________________________________________________________________________________________________________________

Was handler clean and dressed appropriately: _____________________________________________________________________________________________________________________

Did handler offer praise to dog when appropriate: ________________________________________________________________________________________________________________

Was owner friendly with a positive attitude: ______________________________________________________________________________________________________________________

Is Team ready for therapy dog visiting?  PSV (Pass w/supervised visits) PASS  FAIL

OVERALL OBSERVATIONS/COMMENTS

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____________________________________________________________________________________________________________ DATE: _________________________________________________

SIGNATURE Evaluator

_____________________________________________________________________________________________________________ Eddress: ______________ ________________________________

PRINT Evaluator’s Name