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Victim/injured animal information

DOG ATTACK INVESTIGATION

INVESTIGATION TITLE

DATE RECEIVED
INVESTIGATION DATE

REQUEST NUMBER

INVESTIGATING OFFICER
VICTIM INFORMATION

Victim Details

Person

Name

Age

Contact Information

Seriousness of attack

Nature of Injury (select multiple if needed)
Body part affected
Outcome/Treatment

Summery of the Incident

Injury Photographs
INJURED ANIMAL INFORMATION

Number of injured animals

Animal Details

Animal
Animal Type

Breed

Owners Name

Contact Information

Seriousness of attack

Nature of Injury (select multiple if needed)
Body part affected

Outcome/Treatment

Injury Photographs
Description of the Attacking Dog

Dog size

Collar/Distinguishing Marks

Colour

Gender

Address if known

Details of Attack

LOCATION OF ATTACK
Address of incident
Place of occurrence
Photo of incident area (include holes, broken fences etc.)
INCIDENT INFORMATION

Incident classification

Was the attacking dog on a leash?

Was the attacking dog provoked?

Summary of Incident

Is a statement attached?

WITNESSES

Witness information

Witness

Name

Address

Phone number/s

Description of attacking dog/s

Summary of incident

Is a statement attached?

Investigation status

Animal Management (Dogs and Cats) Act 2008

Proposal Issued

Response from animal owner

Regulated Dog Declaration Issued

Infringement Issued

Animal Relinquished

Animal Euthanised

Fraser Coast Regional Council Local law

Infringement Issued

Attacking Dog and Owner Information

ATTACKING DOG INFORMATION
Attacking dog

Owner Name

Address

Phone Number/s

Dogs Name

Registration number

Is the animal registered?

Breed

Gender

Colour

Desexed

Photo of attacking dog

DOG ATTACK INVESTIGATION CHECKLIST

Industry: Community Services | Downloads: 34

Lane Cove Council

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Victim/injured animal information

DOG ATTACK INVESTIGATION

INVESTIGATION TITLE

DATE RECEIVED
INVESTIGATION DATE

REQUEST NUMBER

INVESTIGATING OFFICER
VICTIM INFORMATION

Victim Details

Person

Name

Age

Contact Information

Seriousness of attack

Nature of Injury (select multiple if needed)
Body part affected
Outcome/Treatment

Summery of the Incident

Injury Photographs
INJURED ANIMAL INFORMATION

Number of injured animals

Animal Details

Animal
Animal Type

Breed

Owners Name

Contact Information

Seriousness of attack

Nature of Injury (select multiple if needed)
Body part affected

Outcome/Treatment

Injury Photographs
Description of the Attacking Dog

Dog size

Collar/Distinguishing Marks

Colour

Gender

Address if known

Details of Attack

LOCATION OF ATTACK
Address of incident
Place of occurrence
Photo of incident area (include holes, broken fences etc.)
INCIDENT INFORMATION

Incident classification

Was the attacking dog on a leash?

Was the attacking dog provoked?

Summary of Incident

Is a statement attached?

WITNESSES

Witness information

Witness

Name

Address

Phone number/s

Description of attacking dog/s

Summary of incident

Is a statement attached?

Investigation status

Animal Management (Dogs and Cats) Act 2008

Proposal Issued

Response from animal owner

Regulated Dog Declaration Issued

Infringement Issued

Animal Relinquished

Animal Euthanised

Fraser Coast Regional Council Local law

Infringement Issued

Attacking Dog and Owner Information

ATTACKING DOG INFORMATION
Attacking dog

Owner Name

Address

Phone Number/s

Dogs Name

Registration number

Is the animal registered?

Breed

Gender

Colour

Desexed

Photo of attacking dog