House Check Form

Start Date:  ____________________________         End Date: _________________________________
Name: ______________________________________________________________________________
Address: ____________________________________________________________________________
Phone / Cell:  ________________________________________________________________________
Alarmed?     Yes / No             If Yes, do you have a permit?   Yes / No

LOCAL CONTACT
Primary Contact:                                                                                                         Has a key?   Yes / No
            Name: ________________________________________________________________________
            Address: ______________________________________________________________________
            Phone / Cell: ___________________________________________________________________
 
Secondary Contact:                                                                                                     Has a key?  Yes / No
            Name: ________________________________________________________________________
            Address: ______________________________________________________________________
            Phone / Cell: ___________________________________________________________________
 
Will anyone else be at the house?   Yes / No
 Name: ________________________________        Vehicle Description: __________________
 
LIGHTS
 Inside (times, area): ___________________________________________________________________
Outside (times, area): __________________________________________________________________
 
VEHICLES
 In the driveway (make, model, year) ______________________________________________________
In the garage (make, model, year) ________________________________________________________
 
OTHER
 Outside cellar door?  Yes / No                       Toolshed?   Yes / No              Pool?   Yes / No
       Locked?  Yes / No                       Locked?      Yes / No
 
5/2016