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Vacation House Check
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Residence Information
Occupant Name (First and Last Name) *  
Address *  
City *  
Zip Code  
Phone Number *  
Email Address  
Trip Information
Departure Date *
Departure Time  
Return Date *
Return Time  
Residence Activity
Is there an alarm at the residence? Yes    No   
If yes, could the alarm go off if doors are checked? Yes    No   
Are door screens unlocked? Yes    No   
Are any windows intentionally left open? Yes    No   
Are the gates to back yard locked? Yes    No   
Is it okay to go in the back yard? Yes    No   
Is there a dog in the yard? Yes    No   
Is a radio left on inside? Yes    No   
Are lights left on inside? Yes    No   
Description of vehicles parked at residence (make, model, color, etc.)
Residence Schedule
Does a landscaper come to the residence? Yes    No   
If yes, name of the landscaper  
Does pool care come to the residence? Yes    No   
If yes, name of pool care  
Does a maid or animal sitter come to the residence? Yes    No   
If yes, name  
Emergency Contact Information
First and Last Name  
Address  
City  
Zip Code  
Home Phone Number  
Work Phone Number  
Cell Phone Number  
Does the contact person have a house key? Yes    No   
Will someone be picking up packages / papers? Yes    No   
Phone Number where you can be reached  
Comments / Special Instructions
 


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