Victim/injured animal information

DOG ATTACK INVESTIGATION

INVESTIGATION TITLE

DATE RECEIVED
INVESTIGATION DATE

REQUEST NUMBER

INVESTIGATING OFFICER
VICTIM INFORMATION

Victim Details

Person

Name

Contact Information

Age

Seriousness of attack

Nature of Injury (select multiple if needed)
Body part affected
Outcome/Treatment

Summery of the Incident

Injury Photographs
INJURED ANIMAL INFORMATION

Number of injured animals

Animal Details

Animal
Animal Type

Breed

Owners Name

Contact Information

Seriousness of attack

Nature of Injury (select multiple if needed)
Body part affected

Outcome/Treatment

Injury Photographs
Description of the Attacking Dog

Dog size

Collar/Distinguishing Marks

Colour

Gender

Breed if Known

Owners Address if known

Details of Attack

LOCATION OF ATTACK
Address of incident
Place of occurrence
Photo of incident area (include holes, broken fences etc.)
INCIDENT INFORMATION

Was the attacking dog on a leash?

Was the attacking dog provoked?

Summary of Incident

Is a statement attached?

WITNESSES

Witness information

Witness

Name

Address

Phone number/s

Description of attacking dog/s

Summary of incident

Investigation status

Notice Issued

Date of Notice
Order issued

Attacking Dog and Owner Information

ATTACKING DOG INFORMATION
Attacking dog

Owner Name

Address

Phone Number/s

Dogs Name

Registration number

Is the animal registered?

Breed

Gender

Colour

Desexed

Photo of attacking dog
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.