Zoo Animal Behavior Evaluation Questionnaire

This questionnaire is only for zoo or animal professionals. If you are interested in submitting pet behavior questions please click here. For items you may not know or do not apply please put N/A. All items are vital to help properly assess your situation. Each questionnaire is geared to dealing with one primary problem. Visit here if you need a printable form or you can return to the index now.

Today's Date: Type of Consultation Desired: How did you find our site?

This form is for zoo animal and bird consultations only. All other species may click here for appointments and direction to the right form. Please note: We do not conduct aggression cases in the column, over the phone or via email.

HUMAN INFORMATION

Name of person working on this problem: email address@host:
Mailing address of instituion (Street or PO Box): City: State:
Country: Postal(Zip)Code:
Your Time Zone Daytime Phone: Fascimile:
Supervisor: Supervisor's Phone:

List other participants/M or F /relationship to animal/time on area or string:

Please explain the staff training experiences and relationships with animals

Have you ever attended a training program or behavior seminar before? Yes No
If yes, did you complete the program? Yes No Certificate awarded? Yes No
Who conducted the program or seminar?

PROBLEM BEHAVIOR(S) :
1) Briefly describe problem 2) the age when first observed 3) how long the problem has been in existence 4) where it occurs
5) what particular situation it occurs in 6) frequency 7) how you have attempted to correct it.

ENVIRONMENT INFORMATION

Please list the other animals in the exhibit:
Name Breed/Species Age/Sex*/Compatibility with this animal
* (Please note neutered animals with an N next to sex listed)

The environment is a: Does the animal have a private area or den? Yes No

ANIMAL INFORMATION

Animal Call Name: Sex: M F Breed/Species: Neutered/Implant? Yes No
If yes, at what age? Current Age: Approximate Birthday:

List any of the animal's health or physical problems (Past, Present, Current):

Is this animal on medication? Yes No
If yes, What? & Why?

Was this animal ever seriously injured Yes No or ill? Yes No
If so, please explain:
Is animal current on all required immunizations? Yes No
Veterinarian: Name
Clinic City, State Phone (w/AC)

Age this animal was obtained: From where?
Age taken from mother?
Litter behavior/birth order? How long have you had this animal?
Is this animal an SSP candidate? Yes No If yes, explain:

Does problem occur frequently ? Yes No Where & How Often?

Is your animal kept outside the group? Yes No Where?

Where does this animal sleep? Where does the animal eat?
Does this animal eat with others Yes No Who feeds the pet?
Brand name of food: List sample diet How many times per day?
What type of supplements does your animal receive?

How often is your animal give enrichment or training?
What types? How many enrichment devices do these animals have?
Has this animal ever received any formal training? Yes No At what age?
Trainer's Name: Type of Training: City/State:
Training Methods:
How have you reinforced good behaviors?
How have you reprimanded for inappropriate behaviors?
Animal's reaction to these actions?:
Has your animal grabbed, kicked, nipped or bitten anyone? Yes No How many times has this occurred?
Please detail ALL incidents & explain the circumstances:
How long ago was the first time? How long ago was the last incident?
In stress situations (new situation, strangers, visitors, left alone, confinement, etc.,) how does this animal react:
Would you describe this animal as: Wildly active Active Confident, Assured Reserved Withdrawn Stiff, Lethargic Fearful, Unsure