IMPOUND

IMPOUND INFORMATION
Animal impounded

Impound reason

Location seized
Location Animal Found
ANIMAL INFORMATION

Animal

Gender

Breed

Colour

Desexed

Microchip No

Collar / Distinguishing Marks

Animal Photo

OWNER/RELEASE INFO

OWNER INFORMATION

Owner Details

Address

Phone Number

Date Contacted
RELEASE INFORMATION

Officer

Release Reason

Owner Name

Agents Name if dog not returned to owner

Date
Signature

Infringement Number

Other information or comment

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.