Information
DOG ATTACK
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Document No.
Victim/injured animal information
DOG ATTACK INVESTIGATION
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INVESTIGATION TITLE
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DATE RECEIVED
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INVESTIGATION DATE
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REQUEST NUMBER
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INVESTIGATING OFFICER
- Daniel Novak
- Mandi Althaus
- John Morrison
- Steve Ash
- Sheldon Roderick
- Dave Lester
- Shayne Allanson
VICTIM INFORMATION
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Victim Details
Person
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Name
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Age
- Infant (under 12 months)
- Pre-school (1-5)
- Child (5-10)
- Adolescent (10-18)
- Young Adult (18-25)
- Adult (25-55)
- Senior(55+)
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Contact Information
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Seriousness of attack
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Nature of Injury (select multiple if needed)
- bruising
- abrasion
- puncture
- cut/laceration
- crush injury
- fracture
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Body part affected
- head/face
- neck
- arms/hands
- front torso
- back torso
- buttocks
- legs/feet
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Outcome/Treatment
- None
- First Aid
- GP consult
- Accident & Emergeny
- Ambulance
- Fatality
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Summery of the Incident
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Injury Photographs
INJURED ANIMAL INFORMATION
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Number of injured animals
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Animal Details
Animal
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Animal Type
- dog
- cat
- poultry
- sheep
- cattle
- other
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Breed
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Owners Name
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Contact Information
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Seriousness of attack
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Nature of Injury (select multiple if needed)
- bruising
- abrasion
- puncture
- cut/laceration
- crush injury
- fracture
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Body part affected
- head
- neck
- back
- abdomen
- fore-legs
- hind-legs
- tail
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Outcome/Treatment
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Injury Photographs
Description of the Attacking Dog
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Dog size
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Collar/Distinguishing Marks
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Colour
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Gender
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Address if known
Details of Attack
LOCATION OF ATTACK
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Address of incident
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Place of occurrence
- Owner/keepers property
- Public place
- School
- Farm
- Friends/relatives property
- In/from a vehicle
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Photo of incident area (include holes, broken fences etc.)
INCIDENT INFORMATION
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Incident classification
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Was the attacking dog on a leash?
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Was the attacking dog provoked?
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Summary of Incident
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Is a statement attached?
WITNESSES
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Witness information
Witness
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Name
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Address
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Phone number/s
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Description of attacking dog/s
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Summary of incident
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Is a statement attached?
Investigation status
Animal Management (Dogs and Cats) Act 2008
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Proposal Issued
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Response from animal owner
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Regulated Dog Declaration Issued
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Infringement Issued
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Animal Relinquished
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Animal Euthanised
Fraser Coast Regional Council Local law
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Infringement Issued
Attacking Dog and Owner Information
ATTACKING DOG INFORMATION
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Attacking dog
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Owner Name
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Address
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Phone Number/s
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Dogs Name
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Registration number
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Is the animal registered?
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Breed
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Gender
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Colour
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Desexed
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Photo of attacking dog