Therapy Animal Health & Welfare Log (Animal/Handler)

Therapy Animal Health & Welfare Log

(This is an operational safety and welfare log for therapy animal visits in healthcare facilities. It is not a patient therapy progress note.)

(Do not leave safety-critical fields blank. If information is unavailable, explicitly document "not assessed" or "unknown." Safety-critical fields include: Pre-Session Clearance Decision, Infection Control Exposure Flag, Incident documentation when applicable, and Post-Session Eligibility.)

Date: [Date]

Start/End Time: [Start time] – [End time]

Facility/Site: [Facility or site name and unit/area]

Program: [Program name]

Author/Role: [Name and role/title]

Encounter/Visit ID: [Encounter or visit ID] (Include only if the system uses encounter linkage.)

Animal/Handler Team

Animal Name: [Animal name]

Species: [Species]

Animal ID: [Microchip or program ID]

Handler Name: [Handler full name]

Handler ID: [Handler program ID or credential ID]

Team Certification: [Certifying organization and expiration date] (If applicable. Detailed credentials may be stored in a master record; this section confirms team identity for this session.)

Pre-Session Eligibility

Veterinary Clearance Status: [Brief status of vaccine currency, parasite prevention, and wellness exam; note any active restrictions or holds]

Animal Wellness Screen (day-of-visit): [Narrative summary of handler-performed assessment covering GI signs, respiratory signs, skin integrity, ectoparasites, pain/mobility concerns, behavioral readiness versus baseline, and grooming status] (If any element was not assessed, explicitly state "not assessed" for that element.)

Cleared to Participate: [Yes / Yes with Restrictions / No] (Required. If restrictions apply, specify them. If not cleared, document the reason and required follow-up.)

Session Summary

Visit Type: [Individual rooms / Group session / Staff support / Other]

Locations Visited: [Units, areas, or rooms visited]

Total Active Interaction Time (minutes): [Number]

Number of Patient/Staff Contacts: [Number or separate counts]

Breaks Taken: [Number and duration]

Water Provided: [Yes / No / Unknown]

Elimination Opportunities: [Provided / Not provided / Unknown]

Cumulative Workload: [Sessions today; sessions this week] (Include only if program tracks cumulative workload.)

Welfare Observations

(Required for every session. Do not infer absence of stress; explicitly document if none observed.)

Baseline Presentation at Arrival: [Demeanor, sociability, ability to disengage]

Stress Signals Observed: [Either "no stress signals observed" OR detail observed signals including autonomic signs, displacement behaviors, avoidance/withdrawal, hypervigilance, or aggression warnings with timing and context]

Environmental Triggers and Mitigation: [If stress observed: describe triggers and actions taken. If no stress observed: "not applicable."]

Recovery and Post-Session Demeanor: [Returned to baseline / Partial recovery / Did not recover]; [Post-session demeanor description]

Infection Control

• Hand Hygiene: [Performed before and after contacts / Partially / Not verified]
• Barrier Use for Bed/Lap Contact: [Used / Not used / Not applicable / Not verified]
• Saliva Contact Minimized: [Yes / Partially / Not verified]
• No Contact with Invasive Devices or Wounds: [Maintained / Breach observed / Not verified]
• Off-Limits Areas Avoided: [Yes / No / Not verified]
• Waste Cleanup Preparedness: [Supplies available / Not available / Not verified]

Deviations or Concerns: [Narrative of any deviations or controls that could not be verified; if none, state "none"]

Exposure Concerns: [None / Potential / Confirmed] (Required. If Potential or Confirmed, complete the Incidents section.)

Incidents

(Include only if an incident occurred or Exposure Concerns is Potential/Confirmed. Incidents include: bite, scratch, snap, or aggressive behavior; elimination accident or vomiting; contact with medical devices, wounds, or sterile areas; allergic reaction in a participant; animal injury; or exposure to human infectious risk. Duplicate the block for multiple incidents.)

Incident Date/Time and Location: [Date/time; unit/area]

What Occurred and Who Was Involved: [Concise description] (Use minimal identifiers for involved persons.)

Immediate Actions Taken: [Actions taken]

Notifications Made: [Unit staff / Program liaison / Infection prevention / Risk management / Other]

Animal/Team Disposition: [Visit continued / Visit terminated / Team suspended pending review / Other] (Any bite or scratch requires documentation of termination decision.)

Incident Report Filed: [Yes / No / Pending] (Include reference number if applicable.)

Post-Session Assessment

Post-Session Wellness Status: [New concerns observed OR "no new concerns reported"]

Eligibility for Next Session: [Cleared / Cleared with Restrictions / Not Cleared] (Required.)

Follow-Up Required: [Rest period / Veterinary evaluation / Behavioral reevaluation / Program coordinator review / Equipment or environment modifications / None] (If follow-up depends on an external party, specify what is pending and who is responsible.)

Attestation

I attest that the information above is accurate and complete to the best of my knowledge, and that the session was modified or ended as needed to protect animal welfare and participant safety.

Handler Signature: [Name] Date/Time: [Date/time]

Co-Signer: [Name/Role] Date/Time: [Date/time] (Include only if local policy requires clinical oversight.)