FCRC Dog Attack Investigation Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Document Reference

• Councillor Request

  Yes

  No

  N/A

• Request Type

• Date Received

  Date

• Actioning Officer

• File No

• Subject Address
  Address

• Calling Card Dates

• Inspection Date and Time

  Date

Complaint Interview

• Date and Time

  Date

• Method of Interview

• Name

• Address
  Address

• Contact Number

• Location of Incident
  Address

• Date and Time of Incident

  Date

• Description of Dog

• Nature of Injury

• Statement of Complainant

• Officer's Comments

• Photographs of Injury

  Media

• Date and Time

  Date

• Method of Interview

• Name

• Address
  Address

• Contact Telephone Number

• Entry Denied

  Yes

  No

  N/A

• Incident

• Are you aware that this incident occurred?

  Yes

  No

  N/A

• How did the subject animal escape from where it was being kept?

• Were you aware that the subject animal could escape the enclosure?

  Yes

  No

  N/A

• Is the subject animal registered?

  Yes

  No

  N/A

• Additional information/further questions

• Statement of Keeper

• Officer's Comments

Dog Details

• Dog Name

• Breed

• Colour

• Gender

  Select Male Female

  • Male
  • Female

• Reference No.

• Registered

  Yes

  No

  N/A

• Photographs

  Media

Witness Interview

• Date and Time

  Date

• Method of Interview

• Name

• Address
  Address

• Contact Telephone Number

• Date and Time of Incident

  Date

• Statement of Witness

• Officer's Comments

Investigation Summary

• Prima-facie evidence that and attack occurred

• Prima-facie evidence to identify subject dog

• Prima-facie evidence that subject dog was responsible for attack

• Dangerous dog declaration recommendation

  Yes

  No

  N/A

• Approved By Local Law Team Leader

  Sign

• Date

  Date

• Approved by Animal Management Coordinator

  Sign

• Date

  Date

• Approved by Animal & Pest Services Manager

  Sign

• Date

  Date

• Action taken

• Seizure

  Yes

  No

  N/A

• Kennel No.

• Date

  Date

• Complainant advised of Council action