• Audit Title

  • Conducted on

  • Location
  • Conducted by

  • DWS #



  • Animal impounded

  • Impound reason


  • 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


Companion Animal Register OWNER INFORMATION

  • Owner Details

  • Address

  • Phone Number

  • Date Contacted


  • 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


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.