Match-Up II Manual - Center for Shelter Dogs

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Match-Up II®Shelter Dog Rehoming ProgramAppendix C:Behavioral Triage Worksheet
Behavioral TriageDog’s Name: ___________________________ ID#____________M N F S Breed: ______________________ Age: ____________TOTAL TRIAGEPOINTS:SECTION 1: BEHAVIORAL HISTORY refer to Intake HistoryA. NO INTAKE HISTORY AVAILABLE (Check box)Check box on the right, if no intake history and skip to Section 2. Add 3 pts to Section 1 Behavioral History Total.+3B. AGGRESSION (Check box)1. Attack or uninhibited bite resulting in severe injury to a person (such as a bite that requires stitches ormultiple bites even if no medical care is required)+502. To Adults – Check all that apply, then circle and add only the highest points to Section 1 Behavioral History Total. (Check box)A. Show teeth, growl – Adults Men WomenB. Snap – Adults Men WomenC. Bite – Adults Men WomenNote: If aggression in 2a-2c occurs while breaking up a dog fight or if the dog was in severe pain subtract 5 points.SUBTRACT a maximum of 5 points in this section.If any aggression to adults in Sub-Section 2, answer the following questions but don't add any points (target is always an adult):+6+8+12–52.1. Was it over food?2.2. Was it over bones, rawhides, or chews?2.3. Was it over toys?2.4. Was it over stolen objects?2.5. Was it when the dog was disturbed while sleeping or resting?2.6. Was it when a person handled the dog (brushing, handling feet, bathing, teeth brushing, ear cleaning, etc.but do NOT include reaction to vet or groomer)?2.7. Was it when a person entered the house or yard?2.8. Was it when a person approached or reached toward the dog?3. To Children – Check all that apply but add only the highest points to Section 1 Behavioral History Total.A. Show teeth, growl – ChildrenB. Snap – ChildrenC. Bite – ChildrenNote: If aggression in 2a-2c occurs while breaking up a dog fight or if the dog was in severe pain subtract 5 points.SUBTRACT a maximum of 5 points in this section.YesYesYesYesYesYesYesYes(Check box)NoNoNoNoNoNoNoNo+8+10+14–5Dog’s Name: ___________________________ ID#____________ Date_________________Behavioral Triage Points Form 1 of 9
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Page 10 and 11: Sub-Test 10: Strange-Looking WomanH
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Page 19 and 20: Dog Name:__________________________
Page 21 and 22: Dog Name:__________________________
Page 23 and 24: Dog Name:__________________________
Page 25: Dog Name:__________________________
Page 31 and 32: SUB-TEST 10 - STRANGE-LOOKING WOMAN
Page 33 and 34: 4. To Vet/Groomer - Check all that
Page 35: Triage Point Range Descriptions0-3

Match-Up II Manual - Center for Shelter Dogs

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