My Homemade Behavior Checklist

Owner’s name ____________________________Pet’s name ________________________ Date ______

Behavior Checklist

The list below is divided into sections according to types of behavior problems.  Please indicate below what problems your pet is experiencing by placing a check in the corresponding block.  Please then go to the sections that specify the type of behaviors you have checked and complete those sections in accordance with the rating scale indicated below.

—        Eating behaviors

—        Unruliness and attention related behaviors

—        Stereotypic and repetitive behavior

—        Stress and anxious type behaviors (including fearful types)

—        Urination and defecation

—        Vocalization

—        Sexual behaviors

—        Predatory behavior

—        Threatening, dangerous behavior

Please complete the following checklist rating the behavior problem on a scale of 0-5 as follows:

0-      No concern about behavior/behavior does not exist

1-      little to no concern about behavior/behavior rarely occurs

2-      slightly concerned about the behavior/behavior occurs occasionally

3-      moderate concern regarding behavior/behavior occurs often

4-      very concerned about behavior/behavior occurs very often

5-      extremely concerned about the behavior, behavior causes great distress, behavior causes harm to animal’s self or others)/behavior is constant

PLEASE INCLUDE IN THE COMMENTS SECTION ANY INSIGHTS YOU HAVE AS TO WHEN AND WHY THE BEHAVIOR OCCURS, as well as any other pertinent information.

Eating Behaviors	Rating	Comments
Possessive of own food	0    1    2    3    4    5
Steals food from people and/or other animals	0    1    2    3    4    5
Eats own feces and/or feces of other animals	0    1    2    3    4    5
Eats other inanimate objects or inedible substances (please specify)	0    1    2    3    4    5

Owner’s name _____________________________ Pet’s name ________________________ Date __________

Unruliness and Attention Related Behaviors	Rating	Comments
Constantly demands attention	0    1    2    3    4    5
Pushy, disobedient, hard to train, poor with commands	0    1    2    3    4    5
Possessive with toys	0    1    2    3    4    5
Poor on lead	0    1    2    3    4    5
Does not settle	0    1    2    3    4    5
Jumps on people	0    1    2    3    4    5
Nips/grabs at people or clothing	0    1    2    3    4    5
Overly rough with play	0    1    2    3    4    5

Stereotypic and Repetitive Behaviors	Rating	Comments
Licking	0    1    2    3    4    5
Chasing light or other object	0    1    2    3    4    5
Pacing	0    1    2    3    4    5
Chasing tail	0    1    2    3    4    5
Circling	0    1    2    3    4    5

Stress and Anxious Type Behaviors	Rating	Comments
Constantly follows owner or family members	0    1    2    3    4    5
Paces, pants, shakes, will not settle, vocalizes when left alone (please specify)	0    1    2    3    4    5
Destructive when left alone	0    1    2    3    4    5
Anxious behavior during other events or activities within the home/family (please specify)	0    1    2    3    4    5
Shakes, cowers, hides when near strangers	0    1    2    3    4    5
Shakes, cowers, hides when around family and familiar individuals	0    1    2    3    4    5
Shakes, cowers, hides when around other animals	0    1    2    3    4    5

Owner’s name __________________________Pet’s name ________________________ Date _______

Shakes, cowers, hides when around certain objects or situations (please specify)	0    1    2    3    4    5
Shakes, cowers, hides around thunder, loud noises, and other sources of phobias	0    1    2    3    4    5

Urination and Defecation Behaviors	Rating	Comments
Defecates outside of designated area when exhibiting fear behavior	0    1    2    3    4    5
Defecates outside of designated area when exhibiting excitement	0    1    2    3    4    5
Defecates outside of designated area for unknown reasons	0    1    2    3    4    5
Urinates outside of designated area when exhibiting fear	0    1    2    3    4    5
Urinates outside of designated area when exhibiting excitement	0    1    2    3    4    5
Urinates outside of designated area for unknown reasons	0    1    2    3    4    5

Vocalization behaviors	Rating	Comments
Excessively vocal during day when near strangers	0    1    2    3    4    5
Excessively vocal during day for unknown reason	0    1    2    3    4    5
Excessively vocal at night	0    1    2    3    4    5
Other vocalizations (please specify)	0    1    2    3    4    5

Sexual behaviors	Rating	Comments
Mounts	0    1    2    3    4    5
Roams	0    1    2    3    4    5
Masturbates	0    1    2    3    4    5

Predatory behaviors	Rating	Comments
Chases other animals	0    1    2    3    4    5
Kills or injures other animals	0    1    2    3    4    5
Trees other animals	0    1    2    3    4    5

Threatening and Dangerous behaviors	Rating	Comments PLEASE DESCRIBE CONDITIONS
Displays threatening and dangerous behavior (bites, attacks, tears out feathers or fur) to self	0    1    2    3    4    5
Displays threatening and dangerous behavior (biting and attacking) to family and familiar individuals	0    1    2    3    4    5
Displays threatening and dangerous behavior (biting and attacking) strangers	0    1    2    3    4    5
Displays threatening and dangerous behavior (biting, attacking) other animals	0    1    2    3    4    5