Record of Interview

• Conducted on

  Date

• Prepared by

  Select Sam Allan Lydia Beker Buck Cerridwyn Chris McKee Fiona McNeil Craig Neville Mitchell Robinson Ryan Salvesen Danielle Schoner Taleen Toughladjian

  • Sam Allan
  • Lydia Beker
  • Buck Cerridwyn
  • Chris McKee
  • Fiona McNeil
  • Craig Neville
  • Mitchell Robinson
  • Ryan Salvesen
  • Danielle Schoner
  • Taleen Toughladjian

• Incident Type

  Select Litter (Dumped Rubbish) Dog Attack Dog Registration Dog Rush Dog at Large Other

  • Litter (Dumped Rubbish)
  • Dog Attack
  • Dog Registration
  • Dog Rush
  • Dog at Large
  • Other

• Type of 'other'

• Location of incident

• Time of Incident

  Date

• CSR Number

Details of person being interviewed.

• Name of accused

• Addressed of the accused

• ID of the accused.

CAUTION

• (CAUTION) I need to ask you a few questions in relation to an incident that occurred on (insert date above) regarding (Issue listed above) at (location listed above). Before I do, I must let you know that you are not obliged to say or do anything but anything you do say or do may be used as evidence. Officer to initial that the caution has been given.

  Off

  On

• Do you understand this caution

  Yes

  No

  Other

• Do you require a support person, interpreter/Legal person or similar?

  Yes

  No

  Other

• Mention of any support people / notes.

• Question 1

• Question 2

• Question 3

• Question 4

• Question 5

• Question 6

• Question 7

• Question 8

• Question 9

• Question 10

Signature section

• I hereby acknowledge that this statement is true and correct and I make it in the belief that a person making a false statement in the circumstances is liable to the penalties of perjury.

  Sign

Witness Section

• Acknowledgement taken and signature witnessed by me in

• at

  Date

• Add signature

  Sign