House Check Form

Middlesex Township Police Department offers vacation security checks to Middlesex residents. Officers will do a periodic check of the exterior of your home while you are away. Please check the website Police page for additional information about Crime Prevention Strategies.

• What is a House Check? A: Your house will be checked by an Officer on each shift. In other words, your house will be checked about 3 times in a 24 hour period (daylight, afternoon, and night shifts). This, of course, depends on the manpower and availability of Officers.
   
• What does the Officer do when checking my house? A: The Officer will walk around the residence to ensure the house is secured and there are no signs of forced entry. He will also be looking for any signs that unwanted persons, or vehicles have been there. He will watch for things that may seem out of the ordinary. The Officer will log the times of the check in his activity log.
   
• What happens if something is wrong? A: The person(s) you list as an emergency contact will be notified, most likely, you will also be notified immediately afterwards. Don’t forget to give us your cell phone number in case of an emergency.

Complete the form below. Please be as thorough as possible when completing this form. Incomplete form may result in your request being delayed. 

Police Department or County Control MUST be called when you return home.

Full Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Date Leaving *

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

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Year Year20212022202320242025

Time Leaving *

Hour hour123456789101112

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am

pm

Date Returning *

Month MonthJanFebMarAprMayJunJulAugSepOctNovDec

Day Day12345678910111213141516171819202122232425262728293031

Year Year20212022202320242025

Time Returning *

Hour hour123456789101112

:

Minute minute000102030405060708091011121314151617181920212223242526272829303132333435363738394041424344454647484950515253545556575859

am

pm

Key Holder Name *

Street Address

City

State

Zip Code

Phone Number

Vehicle Information *

Authorized Visitors *

Vehicle Information *

Lighting Information (Lights on Timer) *

Other Important Info *

Leave this field blank