Home Owner's Insurance Company:

Agent Name:

Agent Phone #:

Location of Fuse Box (and fuses)/Circuit Box:

Location of Main Water Shutoff:


Location of Gas Shutoff:


Are there timers for any lights?


Location of Thermostat and Normal Setting:


Location of Hot Water Heater:

Location of Hoses:


Service Days for Household (Cleaners, Gardeners, Deliveries, Collections, Etc.)


Special Instructions:
Bring in Mail:     yes    no
Open/Close Blinds or Curtains:     yes    no              
Indoor Plant Care:     yes   no
Outdoor Plant Care:     yes    no   
Bird Feeder:     yes   no 
Wash Bedding:     yes    no 
(for overnights only)
Clean Bath or Shower:     yes    no 
(for overnights only)
Additional Information About the Above Special Instructions:

Location of Cleaning Supplies:


Designated Sleeping Quarters and Bath For Use Of Pet Sitter:


Pet Sitter has permission to use the following devices:
Please check box if O.K. to use.

T.V./VCR/DVD:
Washer/Dryer: 
Dishwasher: 
Stove: 
Refrigerator: 
Other: 

Any Additional Instructions For Home Care:

Client Initials and Date:

Please Press Submit to Send: