IMPOUND FORM

• Audit Title

• Conducted on

  Date

• Prepared by

• Location
  Address

• Trim container #

IMPOUND INFORMATION

• Animal impounded

  Date

• Impound reason

  Wandering at large

  Relinquished

  Dog attack

  Hold

  Abandoned

ANIMAL INFORMATION

• Animal

  Dog

  Cat

  Other

• Breed

• Colour

• Age

• Gender

  Male

  Female

  Unsure

• Desexed

  YES

  NO

  UNSURE

• Registration tag

• Microchip No

• Collar / Distinguishing Marks

• Animal Photo

  Media

OWNER INFORMATION

• Owner Details

• Address

• Phone Number

• Date Contacted

  Date

RELEASE INFORMATION

• Officer

• Release Reason

  Select Owner Pet Warriors Fraser Coast Cat Rescue Wide Bay Animal Refuge Maryborough Refuge Euthanised

  • Owner
  • Pet Warriors
  • Fraser Coast Cat Rescue
  • Wide Bay Animal Refuge
  • Maryborough Refuge
  • Euthanised

• Date

  Date

Lane Cove Council, and its consultants, partners, agents and employees shall not be held liable for any and all claims, losses, expenses, injuries or damages arising by reason of any act or omission, including negligence not amounting to a wilful or intentional wrong during the period of time within which the above described animal was not in your custody or under effective control.

• Infringement Number

RELEASED/REHOMED/EUTHANISED