Dog Attack Report

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

Incident Information

• Date

  Date

• Time

  Date
• Location of Attack
  Address

• Investigating Officer

  Select Yes No N/A

  • Yes
  • No
  • N/A

• No. of Dogs involved in Attack

  1

  2

  3

  4

  5

• No. of Human Victims

  1

  2

  3

  4

  5

• No. of Animal Victims

  1

  2

  3

  4

  5

• Type (dog,cat,sheep,horse,etc)

  Select Dog Cat Sheep Cattle Goats Birds Liama Alpaca

  • Dog
  • Cat
  • Sheep
  • Cattle
  • Goats
  • Birds
  • Liama
  • Alpaca

• Description of Incident

Details of person reporting incident

• Name

• Address
  Address

• Phone No.

• General Statement

INVESTIGATION DETAILS - Human

• Applicable

Victim 1

• Name

• Address

• Phone

• Victim category

  Adult

  Child (Supervised)

  Unsupervised Child

• Severity of Attack

  Select No Injury Minor Injury Medical Treatment Hospitalisation Death

  • No Injury
  • Minor Injury
  • Medical Treatment
  • Hospitalisation
  • Death

• Injuries

• Location

  Select Head Face Right Arm Left Arm Right Hand Left Hand Torso Back Bottom Right Leg Left Leg Right Foot Left Foot

  • Head
  • Face
  • Right Arm
  • Left Arm
  • Right Hand
  • Left Hand
  • Torso
  • Back
  • Bottom
  • Right Leg
  • Left Leg
  • Right Foot
  • Left Foot

• Photos

  Media

• Statement

Victim 2

• Name

• Address

• Phone

• Victim category

  Adult

  Child (Supervised)

  Unsupervised Child

• Severity of Attack

  Select No Injury Minor Injury Medical Treatment Hospitalisation Death

  • No Injury
  • Minor Injury
  • Medical Treatment
  • Hospitalisation
  • Death

• Injuries

• Location

  Select Head Face Right Arm Left Arm Right Hand Left Hand Torso Back Bottom Right Leg Left Leg Right Foot Left Foot

  • Head
  • Face
  • Right Arm
  • Left Arm
  • Right Hand
  • Left Hand
  • Torso
  • Back
  • Bottom
  • Right Leg
  • Left Leg
  • Right Foot
  • Left Foot

• Photos

  Media

• Statement

Victim 3

• Name

• Address

• Phone

• Victim category

  Adult

  Child (Supervised)

  Unsupervised Child

• Severity of Attack

  Select No Injury Minor Injury Medical Treatment Hospitalisation Death

  • No Injury
  • Minor Injury
  • Medical Treatment
  • Hospitalisation
  • Death

• Injuries

• Location

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Photos

  Media

• Statement

INVESTIGATION DETAILS - ANIMALS

• Applicable

Animal 1

• Type

  Select Dog Cat Sheep Cattle Goats Birds Liama Alpaca

  • Dog
  • Cat
  • Sheep
  • Cattle
  • Goats
  • Birds
  • Liama
  • Alpaca

• Severity of Attack

  Select No Injury Minor Injury Medical Treatment Hospitalisation Death

  • No Injury
  • Minor Injury
  • Medical Treatment
  • Hospitalisation
  • Death

• Injuries

• Location

  Select Head Face Right Arm Left Arm Right Hand Left Hand Torso Back Bottom Right Leg Left Leg Right Foot Left Foot

  • Head
  • Face
  • Right Arm
  • Left Arm
  • Right Hand
  • Left Hand
  • Torso
  • Back
  • Bottom
  • Right Leg
  • Left Leg
  • Right Foot
  • Left Foot

• Photos

  Media

Animal 2

• Type

  Select Dog Cat Sheep Cattle Goats Birds Liama Alpaca

  • Dog
  • Cat
  • Sheep
  • Cattle
  • Goats
  • Birds
  • Liama
  • Alpaca

• Severity of Attack

  Select No Injury Minor Injury Medical Treatment Hospitalisation Death

  • No Injury
  • Minor Injury
  • Medical Treatment
  • Hospitalisation
  • Death

• Injuries

• Location

  Select Head Face Right Arm Left Arm Right Hand Left Hand Torso Back Bottom Right Leg Left Leg Right Foot Left Foot

  • Head
  • Face
  • Right Arm
  • Left Arm
  • Right Hand
  • Left Hand
  • Torso
  • Back
  • Bottom
  • Right Leg
  • Left Leg
  • Right Foot
  • Left Foot

• Photos

  Media

Animal 3

• Type

  Select Dog Cat Sheep Cattle Goats Birds Liama Alpaca

  • Dog
  • Cat
  • Sheep
  • Cattle
  • Goats
  • Birds
  • Liama
  • Alpaca

• Severity of Attack

  Select No Injury Minor Injury Medical Treatment Hospitalisation Death

  • No Injury
  • Minor Injury
  • Medical Treatment
  • Hospitalisation
  • Death

• Injuries

• Location

  Select Head Face Right Arm Left Arm Right Hand Left Hand Torso Back Bottom Right Leg Left Leg Right Foot Left Foot

  • Head
  • Face
  • Right Arm
  • Left Arm
  • Right Hand
  • Left Hand
  • Torso
  • Back
  • Bottom
  • Right Leg
  • Left Leg
  • Right Foot
  • Left Foot

• Photos

  Media

ATTACKING DOG DETAILS

• Breed

  Yes

  No

  N/A

• Approx. Age

  Yes

  No

  N/A

• Microchip No.

• Registered

  Yes

  No

  N/A