IMPOUND

IMPOUND INFORMATION
Animal impounded

Impound reason

ANIMAL INFORMATION

Animal

Breed

Colour

Age

Gender

Desexed

Registration tag

Microchip No

Collar / Distinguishing Marks

Animal Photo

Any obvious injuries or suspected medical issues with the animal at time of collection

Photo of injuries
Animal impounded at

OWNER/RELEASE INFO

Companion Animal Register OWNER INFORMATION

Owner Details

Address

Phone Number

Date Contacted
RELEASE INFORMATION
Release Reason

Name of Welfare Group

Officer

Add signature
Date
Copy of forms
Leichhardt 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
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.