Form VPH-1 "Inspection Report of Kennels, Pet Shops, Shelters, and Pounds" - New Jersey

What Is Form VPH-1?

This is a legal form that was released by the New Jersey Department of Health - a government authority operating within New Jersey. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2012;
  • The latest edition provided by the New Jersey Department of Health;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Form VPH-1 by clicking the link below or browse more documents and templates provided by the New Jersey Department of Health.

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Download Form VPH-1 "Inspection Report of Kennels, Pet Shops, Shelters, and Pounds" - New Jersey

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New Jersey Department of Health
INSPECTION REPORT OF KENNELS, PET SHOPS, SHELTERS AND POUNDS
Name of Facility
License No.
Date of Inspection
Address of Facility
Time Began
Time Completed
County/ Municipality
Inspecting Organization
Name of Inspecting Official(s)
Telephone Number
Type of Establishment
Type of Inspection
Result of Inspection
Kennel
Pound
Initial
Complaint
Satisfactory
Unsatisfactory
Pet Shop
Shelter
Routine
Reinspection
Conditional A
Conditional B
This inspection is based on N.J.A.C. 8:23A-1 “Animal Facility Operation” promulgated under the authority
of N.J.S.A. 4:19-15.14. (“X” indicates a violation)
N.J.A.C. 8:23A
N.J.A.C. 8:23A SECTIONS (CONTINUED)
1.2 - COMPLIANCE
1.9 - DISEASE CONTROL
b. Certificate of local inspection
a. Disease control and health care program established
d. Fire inspection
and maintained by a veterinarian:
c. Plan review, if applicable
____________________________
Dr.
b,c,&j. Certificate of veterinary supervision/notification of
1.3 - FACILITIES (GENERAL)
noncompliance/zoonotic disease reporting
a. General housing condition
d. Observation of animals/treatment of injury or illness/
b. Electric power/water test
stress remediation
c. Storage of food and/or bedding
e,k,&l. Handling of rabies suspects
d. Disposal of waste and/or carcasses
f. Isolation of animals with communicable disease
e. Facilities for caretaker’s cleanliness
g,h,&i. Isolation rooms
f. Premises (buildings and grounds)
m&n. Fact sheets/noncompliance of ordered quarantine
1.4 - FACILITIES (INDOOR)
1.10 - HOLDING AND RECLAIMING ANIMALS
a. Indoor facilities/acclimation certificate not provided
a.
1. Seven day stray holding period
b. Heating
1-4. Rabies holding period/rabies testing protocol
c. Ventilation
5-6. Elective euthanasia
d&e. Lighting
b. Facility Sign
f. Interior surfaces not impervious to moisture
b.
1-5. Public access
g. Drainage
6-7. Notification of unlicensed dog/impoundment
1.5 - FACILITIES (OUTDOOR)
1.11 - EUTHANASIA
a,b,&c. Protection from weather elements
a&b. Pre-euthanasia handling/sedation
d. Drainage
c&d. Method of euthanasia
e. Outdoor enclosure surfaces/disposal of run off
e. Persons administering euthanasia
1.6 - PRIMARY ENCLOSURES
f. Euthanasia protocol
a. Primary enclosure requirements
g. Assessment of animals after euthanasia
b,g,&h. Enclosure size/litter receptacle/exercise
1.12 - TRANSPORTATION
c. Segregation of animals
a&b. Vehicle requirements
d. Disinfection between inhabitants
c,e,&f. Primary enclosures
e. Isolating contagious animals
d. Animal segregation
f. Flooring
g. Sanitation of enclosures
i. Suspect rabid animal caging
h. Emergency veterinary care
j. Tethering in lieu of primary enclosures
i. Temporary holding facilities
1.7 - FEEDING AND WATERING
1.13 - RECORDS AND ADMINISTRATION
a&c. Feeding frequency
a,c,&d. Record keeping
b. Food quality
d. Location of food receptacles
b. Records not kept on premise
e,f,&g. Food receptacles
e. Change in facility status
h. Potable water/water receptacles
NJAC 8:23-1 THROUGH 3
1.8 - SANITATION
1.1 Importation of dogs; certification requirements
a. Removal of excreta/protection of animals during
1.2 Reporting of known or suspect rabid animal
cleaning
1.3 Transportation of confined animals
b. Frequency of cleaning
1.4 Quarantine, testing and transportation of pet birds
c. Disinfection practices
1.5 Records of pet birds
d. Condition of buildings/grounds
2.1 Sale of turtle eggs/live turtles
e. Pest control
3.1 Transportation of animals by ACOs
NUMBER OF ANIMALS AT THE FACILITY (List species and numbers)
Species
No.
Other Species
No.
Other Species
No.
Other Species
No.
Dogs
Cats
Signature of Owner, Operator or Representative
Signature of Inspecting Official(s)
VPH-1
Copies to: Local Health Department, NJDOH, Establishment and Inspecting Official
JUL 12
New Jersey Department of Health
INSPECTION REPORT OF KENNELS, PET SHOPS, SHELTERS AND POUNDS
Name of Facility
License No.
Date of Inspection
Address of Facility
Time Began
Time Completed
County/ Municipality
Inspecting Organization
Name of Inspecting Official(s)
Telephone Number
Type of Establishment
Type of Inspection
Result of Inspection
Kennel
Pound
Initial
Complaint
Satisfactory
Unsatisfactory
Pet Shop
Shelter
Routine
Reinspection
Conditional A
Conditional B
This inspection is based on N.J.A.C. 8:23A-1 “Animal Facility Operation” promulgated under the authority
of N.J.S.A. 4:19-15.14. (“X” indicates a violation)
N.J.A.C. 8:23A
N.J.A.C. 8:23A SECTIONS (CONTINUED)
1.2 - COMPLIANCE
1.9 - DISEASE CONTROL
b. Certificate of local inspection
a. Disease control and health care program established
d. Fire inspection
and maintained by a veterinarian:
c. Plan review, if applicable
____________________________
Dr.
b,c,&j. Certificate of veterinary supervision/notification of
1.3 - FACILITIES (GENERAL)
noncompliance/zoonotic disease reporting
a. General housing condition
d. Observation of animals/treatment of injury or illness/
b. Electric power/water test
stress remediation
c. Storage of food and/or bedding
e,k,&l. Handling of rabies suspects
d. Disposal of waste and/or carcasses
f. Isolation of animals with communicable disease
e. Facilities for caretaker’s cleanliness
g,h,&i. Isolation rooms
f. Premises (buildings and grounds)
m&n. Fact sheets/noncompliance of ordered quarantine
1.4 - FACILITIES (INDOOR)
1.10 - HOLDING AND RECLAIMING ANIMALS
a. Indoor facilities/acclimation certificate not provided
a.
1. Seven day stray holding period
b. Heating
1-4. Rabies holding period/rabies testing protocol
c. Ventilation
5-6. Elective euthanasia
d&e. Lighting
b. Facility Sign
f. Interior surfaces not impervious to moisture
b.
1-5. Public access
g. Drainage
6-7. Notification of unlicensed dog/impoundment
1.5 - FACILITIES (OUTDOOR)
1.11 - EUTHANASIA
a,b,&c. Protection from weather elements
a&b. Pre-euthanasia handling/sedation
d. Drainage
c&d. Method of euthanasia
e. Outdoor enclosure surfaces/disposal of run off
e. Persons administering euthanasia
1.6 - PRIMARY ENCLOSURES
f. Euthanasia protocol
a. Primary enclosure requirements
g. Assessment of animals after euthanasia
b,g,&h. Enclosure size/litter receptacle/exercise
1.12 - TRANSPORTATION
c. Segregation of animals
a&b. Vehicle requirements
d. Disinfection between inhabitants
c,e,&f. Primary enclosures
e. Isolating contagious animals
d. Animal segregation
f. Flooring
g. Sanitation of enclosures
i. Suspect rabid animal caging
h. Emergency veterinary care
j. Tethering in lieu of primary enclosures
i. Temporary holding facilities
1.7 - FEEDING AND WATERING
1.13 - RECORDS AND ADMINISTRATION
a&c. Feeding frequency
a,c,&d. Record keeping
b. Food quality
d. Location of food receptacles
b. Records not kept on premise
e,f,&g. Food receptacles
e. Change in facility status
h. Potable water/water receptacles
NJAC 8:23-1 THROUGH 3
1.8 - SANITATION
1.1 Importation of dogs; certification requirements
a. Removal of excreta/protection of animals during
1.2 Reporting of known or suspect rabid animal
cleaning
1.3 Transportation of confined animals
b. Frequency of cleaning
1.4 Quarantine, testing and transportation of pet birds
c. Disinfection practices
1.5 Records of pet birds
d. Condition of buildings/grounds
2.1 Sale of turtle eggs/live turtles
e. Pest control
3.1 Transportation of animals by ACOs
NUMBER OF ANIMALS AT THE FACILITY (List species and numbers)
Species
No.
Other Species
No.
Other Species
No.
Other Species
No.
Dogs
Cats
Signature of Owner, Operator or Representative
Signature of Inspecting Official(s)
VPH-1
Copies to: Local Health Department, NJDOH, Establishment and Inspecting Official
JUL 12