Copy of Grooming Site Assessment Pet Shelter Copy of Grooming Site Assessment Pet Shelter Question Title * 1. Disclaimer: Please note that completing our online assessment does not guarantee the delivery of no-charge grooming services. Our service delivery to the community will be based on the availability of funds and manpower.Note: DO NOT ENTER COMMAS WITHIN ANY NUMERICAL TEXT BOXES ON YOUR ANSWERS. ALL QUESTIONS MUST BE ANSWERED. YOU CANNOT SAVE AND RETURN TO THIS APPLICATION AT A LATER TIME. Note: YOU CANNOT SAVE AND RETURN TO YOUR ANSWERS AT A LATER TIME, THEREFORE THE BEST WAY TO COMPLETE THIS ONLINE ASSESSMENT IS TO... 1) PRINT OUT A COPY 2) GATHER YOUR ANSWERS 3) RETURN TO THIS ONLINE VERSION AND FILL IN YOUR ANSWERS Date Date Question Title * 2. Person filling out this survey Name: Title Email Address: Phone Number: Question Title * 3. Name and address of your Organization Company: * Address: * City/Town: * State: * -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP: * Website or Company Email Address: * Phone Number: Question Title * 4. What year was your organization founded (an estimate is acceptable)? Question Title * 5. Estimated number of staff at your organization as of today Question Title * 6. Estimated number of active volunteers as of today Question Title * 7. Select each geographic area(s) served by your organization (check all that apply) All Maryland Counties (including Baltimore City) Allegany County Anne Arundel County Baltimore City Baltimore County Calvert County Caroline County Carroll County Cecil County Charles County Dorchester County Frederick County Garrett County Harford County Howard County Kent County Montgomery County Prince George's County Queen Anne's County Somerset County St. Mary's County Talbot County Washington County Wicomico County Worcester County All other States list your geographical area(s) served below Question Title * 8. Estimate the average number of non-duplicated animals served by your organization on an annual basis Yearly Average Question Title * 9. Of the total non-duplicated animals served annually, estimate the amount that lack access to regular grooming Question Title * 10. Rate the grooming condition of the animal population that you are currently housing Matted/Infected Extremely poor Poor Below sufficient Sufficient Matted/Infected Extremely poor Poor Below sufficient Sufficient Question Title * 11. Select the common grooming/hygiene problems you observe when interacting with the animals that you currently house Unkempt hair Uncut hair Unclean hair Body odor Question Title * 12. Rank in order the common grooming/hygiene problems that you observe with "1" being the most observed and "4" being least observed (all items must be ranked) 1 2 3 4 Unkempt hair Unkempt hair 1 Unkempt hair 2 Unkempt hair 3 Unkempt hair 4 Uncut hair Uncut hair 1 Uncut hair 2 Uncut hair 3 Uncut hair 4 Unclean hair Unclean hair 1 Unclean hair 2 Unclean hair 3 Unclean hair 4 Body odor Body odor 1 Body odor 2 Body odor 3 Body odor 4 Question Title * 13. What type of grooming support services do your animals lack at this time Haircutting services Grooming products (shampoos & conditioners) Grooming Equipment (haircutting clippers, nail clippers, combs & brushes) Question Title * 14. Rank in order the services needed by the animals housed by your organization with "1" being the service most needed to "6" being the service least needed. (all items must be ranked) 1 2 3 Haircuting Services Haircuting Services 1 Haircuting Services 2 Haircuting Services 3 Grooming Products (shampoos, conditioners, etc.) Grooming Products (shampoos, conditioners, etc.) 1 Grooming Products (shampoos, conditioners, etc.) 2 Grooming Products (shampoos, conditioners, etc.) 3 Grooming Equipment (electric hair clippers, nail clippers, brushes, combs, etcs.) Grooming Equipment (electric hair clippers, nail clippers, brushes, combs, etcs.) 1 Grooming Equipment (electric hair clippers, nail clippers, brushes, combs, etcs.) 2 Grooming Equipment (electric hair clippers, nail clippers, brushes, combs, etcs.) 3 Question Title * 15. Check any barrier(s) that your organization has concerning regular grooming services for your currently housed animals Lack of available funds to hire professional groomers Unable to afford to send animals to a professional groomer Unable to transport animals to a nearby grooming facility Lack of professional animal grooming sevices within a 10 mile radius None of the above Other (please specify) Question Title * 16. Rank in order your organization's barrier(s) to providing regular grooming services and products to your animals with "1" being the greatest barrier and "5" the least barrier. All items must be ranked (including "none") 1 2 3 4 5 Lack of available funds to hire professional groomers Lack of available funds to hire professional groomers 1 Lack of available funds to hire professional groomers 2 Lack of available funds to hire professional groomers 3 Lack of available funds to hire professional groomers 4 Lack of available funds to hire professional groomers 5 Unable to send animals to a proffesional groomer Unable to send animals to a proffesional groomer 1 Unable to send animals to a proffesional groomer 2 Unable to send animals to a proffesional groomer 3 Unable to send animals to a proffesional groomer 4 Unable to send animals to a proffesional groomer 5 Unable to transport animals to a nearby grooming facility Unable to transport animals to a nearby grooming facility 1 Unable to transport animals to a nearby grooming facility 2 Unable to transport animals to a nearby grooming facility 3 Unable to transport animals to a nearby grooming facility 4 Unable to transport animals to a nearby grooming facility 5 Lack of professional groomers within a 10 mile radius Lack of professional groomers within a 10 mile radius 1 Lack of professional groomers within a 10 mile radius 2 Lack of professional groomers within a 10 mile radius 3 Lack of professional groomers within a 10 mile radius 4 Lack of professional groomers within a 10 mile radius 5 None None 1 None 2 None 3 None 4 None 5 Question Title * 17. If any, select any other organizational barriers to providing grooming services to your housed animal population. Check all that apply, then list any other barriers if applicable Lack of technical assistance on how we can operate our own grooming area in our facility Lack of funding to operate a full-service grooming area in our facility Lack of available personnel to oversee a grooming area in our facility Lack of onsite trained staff to provide grooming services No barriers Other (please specify) Question Title * 18. Rank in order what are your organization's barriers to providing grooming services to your animal population with "1" being the greatest barrier and "5" being the least greatest barrier. All items must be ranked (including "no barriers") 1 2 3 4 5 Lack of technical assistance on how we can operate our own grooming area in our facility Lack of technical assistance on how we can operate our own grooming area in our facility 1 Lack of technical assistance on how we can operate our own grooming area in our facility 2 Lack of technical assistance on how we can operate our own grooming area in our facility 3 Lack of technical assistance on how we can operate our own grooming area in our facility 4 Lack of technical assistance on how we can operate our own grooming area in our facility 5 Lack of funding to operate a full-service grooming area in our facility Lack of funding to operate a full-service grooming area in our facility 1 Lack of funding to operate a full-service grooming area in our facility 2 Lack of funding to operate a full-service grooming area in our facility 3 Lack of funding to operate a full-service grooming area in our facility 4 Lack of funding to operate a full-service grooming area in our facility 5 Lack of available personnel to oversee a grooming area in our facility Lack of available personnel to oversee a grooming area in our facility 1 Lack of available personnel to oversee a grooming area in our facility 2 Lack of available personnel to oversee a grooming area in our facility 3 Lack of available personnel to oversee a grooming area in our facility 4 Lack of available personnel to oversee a grooming area in our facility 5 Lack of trained onsite staff to provide grooming services Lack of trained onsite staff to provide grooming services 1 Lack of trained onsite staff to provide grooming services 2 Lack of trained onsite staff to provide grooming services 3 Lack of trained onsite staff to provide grooming services 4 Lack of trained onsite staff to provide grooming services 5 No barriers No barriers 1 No barriers 2 No barriers 3 No barriers 4 No barriers 5 Question Title * 19. Check what would be the increased benefit(s) to your housed animals if they receive regular access to grooming equipment, products and services(check all that apply) Animals will now have improved grooming and hygiene Animals will now have maintained grooming and hygiene Our organization will now have access equipment and products that were are currently unable to afford None Question Title * 20. Rank in order those same increased benefits with "1" being the greatest impact to "7" being the least impact of regular access grooming equipment, products and services to your housed animals. All items must be ranked (including "none") 1 2 3 4 Animals will now have improved grooming and hygiene Animals will now have improved grooming and hygiene 1 Animals will now have improved grooming and hygiene 2 Animals will now have improved grooming and hygiene 3 Animals will now have improved grooming and hygiene 4 Animals will now have maintained grooming and hygiene Animals will now have maintained grooming and hygiene 1 Animals will now have maintained grooming and hygiene 2 Animals will now have maintained grooming and hygiene 3 Animals will now have maintained grooming and hygiene 4 Our organization will now have access to equipment and products that we are currently unable to afford Our organization will now have access to equipment and products that we are currently unable to afford 1 Our organization will now have access to equipment and products that we are currently unable to afford 2 Our organization will now have access to equipment and products that we are currently unable to afford 3 Our organization will now have access to equipment and products that we are currently unable to afford 4 None None 1 None 2 None 3 None 4 Question Title * 21. List any other way(s) that grooming serivces will benefit your organization's animal population (if there are no additional benefits place "N/A" in each textbox). 1. 2. 3. 4. 5. Question Title * 22. Is there space to conduct the grooming services at your organization?(at least 7' by 7') Yes No Question Title * 23. Does your organization allocate money in the budget specifically to provide grooming services to your housed animal population Yes No Question Title * 24. What is the current range of your organization's annual budget $0 - $100,000 $100,000 - $200,000 $200,000 - $300,000 $400,000 - $500,000 $500,000 - $1,000,000 $1,000,000 and above Question Title * 25. As a condition of receiving grooming equipment and products from the RBCF, you organiztion must fill out a monthly online form that will measure the project's impact on your animal populations' current condition (12 month period). I agree I do not agree Question Title * 26. Would your organization like to... fund the cost of this project have the RBCF seek funding for this project speak with the RBCF before you decide on how to fund the project Question Title * 27. Does your organization have a volunteer program and/or volunteer coordinator? Yes No Question Title * 28. List the name, title, phone and email of the individual who can be assigned as a contact person for the RBCF Name: Title Email Address: Phone Number: Done