Impound Form - Fraser Coast Regional Council 6.0

• Document No.

• Audit Title

• Impounded by

• Pen Number

• Date Impounded

  Date

• Date available

  Date

• Impound Reason

  Wandering at Large

  Relinquished

  On Hold

  Investigation

  Seized

• Location seized

• Publish on Facebook

  YES

  No (Owner must be known)

• Available for rehome

  Yes

  Owner only

  Conditions apply

ANIMAL INFORMATION

• Breed

• Colour

• Age

• Gender

  Select ENTIRE MALE DESEXED MALE ENTIRE FEMALE DESEXED FEMALE UNKNOWN DESEXED UNKNOWN

  • ENTIRE MALE
  • DESEXED MALE
  • ENTIRE FEMALE
  • DESEXED FEMALE
  • UNKNOWN
  • DESEXED UNKNOWN

• Registration Tag

• Microchip (date and initial if not found)

• Collar/Distinguishing Marks

• Notes

• Animal photo

  Media

OWNER INFORMATION

• Name and Phone Number

• Address

• Number of Impounds/warnings

• Date Contacted

  Date

• Notes

RELEASE INFORMATION

• Released by

• Date Released

  Date

• 2nd Microchip Scan (date and initial)

• Lost and Found Checked

• Animal Rescue Claim Checked

• Remove from Facebook

• Release Reason

• Receipt/infringement number

• Release Approved by (Supervisor)

PENALTIES APPLY FOR UNLAWFUL REMOVAL OF SEIZED OR IMPOUNDED ANIMAL WITHOUT THE APPROVAL OF AN AUTHORISED PERSON.

• Signature

  Sign