Information

  • Document No.

  • Audit Title

  • Conducted on

IMPOUND

  • Impounding Officer

  • Pen Number

  • Animal impounded

  • Date available

  • Impound reason

  • Location seized
  • Publish on the Internet

  • Available for rehome

ANIMAL INFORMATION

  • Animal

  • Breed

  • Colour

  • Age

  • Gender

  • Desexed

  • Registration tag

  • Microchip No

  • Collar / Distinguishing Marks

  • Animal Photo

OWNER/RELEASE INFO

OWNER INFORMATION

  • Owner Details

  • Address
  • Phone

  • Date Contacted

  • Notes / Number of Impounds

RELEASE INFORMATION

  • Does the animal have a current investigation ongoing?

  • Contact Officer

  • Investigation type

  • CP Number

  • Approved for Release

HOLD PENDING INVESTIGATION

  • Release Approved by

  • Releasing Officer

  • Date

  • Lost and found checked

  • Animal rescue claim checked

  • Release Reason

  • Receipt / Infringement number

I acknowledge as the owner/keeper of this animal I am liable for all claims, losses, expenses, injuries or damages during the period of time which the above described animal was not in your custody or under effective control.

  • Collectors Signature

  • Euthanised

Form

FORM

  • Animal Number

  • Impound Fee $114.50

  • Registration Fee

  • Sustenance Fee

  • Amount

  • TOTAL FEES PAYABLE

  • Officer Name

  • Officer Signature

  • Date

  • A wandering at large penalty of $227.00 also applies if your animal is unregistered or has been impounded previously in the last 12 months. If applicable, this fine will be sent to you via Australia Post.

  • Wandering At Large Penalty

Office Use Only

  • Received By

  • Date

  • Existing Registration

  • New Registration

Fees above are taken from Council's Fees & Charges and penalties set by Council Local Laws.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.