Cochran, GA: House Check Request Form

We will check your residence several times daily while you are out of town. House checks are performed free of charge for City residents while away on vacation or business. Request forms are available at our office, or fill out the following online form.
Departure Date and Time:*

MonthDayYearHourMinutesAM/PM Option
Occupant Information
Name:*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number:*
Format: (000) 000-0000.
Email Address:*
Vacation Information
Date Returning:

MonthDayYear
Is there an alarm at the residence?

YesNo
Could the alarm go off if doors are checked?

YesNo
Are door screens unlocked? (Screens should be left unlocked so doors can be checked)

YesNo
Are any windows intentionally left open?

YesNo
Does a lawn maintenance person come to the residence?

YesNo
- Name of the company:
- Residence schedule:
- Does pool care come to the residence?
  
  YesNo
- Name of the company:
- Residence schedule:
- Does a maid or animal sitter come to the residence?
  
  YesNo
- Name of the company:
- Residence schedule:
- Are the gates to back yard locked?
  
  YesNo
- Is it okay to go into the backyard?
  
  YesNo
- Is there a dog in the backyard?
  
  YesNo
- Is a radio left on inside?
  
  YesNo
- Do you have any lights on?
  
  YesNo
- Location of lights:
- Any vehicles in driveway?
  
  YesNo
- Vehicle description
- Emergency Contact Information
- Name (Emergency Contact)*
  
  First NameLast Name
- Address:*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Phone Number*
  Format: (000) 000-0000.
- Does Emergency Contact Have Key?*
  
  YesNo
- Will someone be picking up packages/papers?
  
  YesNo
- Phone Number where you can be reached:
  Format: (000) 000-0000.
- Comments/Special Instructions:
- Please verify that you are human*
- Should be Empty:

Occupant Information

Vacation Information

Emergency Contact Information