Initial Information

Date Complaint Received

Contact Person's Name

Contact Person's #

Contact Person's Email

Address/Crossroads of Horse(s)

Original Contact Details

Number of Horses
Original Pictures Received

Investigation Findings

RVR Lead Investigator For Case

Date/Time of Investigation

Who went with you on this investigation?

Owner's Name

Owner's contact information

Investigation Findings

Photos of Investigation
Follow Up Needed?

Animals Released?

Photo of Release Form

Legal Concerns

Has AG/Authorities Been Involved?

If in past when were they involved?

Outcome of authority involvement

Is AG/Authorities Currently Involved?

Why are they involved?

AG/Authority Contact Name

Contact Phone

Horse Questions

Please complete the following questions for each horse involved. Tap "Add Horse" to fill out information for each additional horse.

Sex of Horse
Body Score

Any Known/Obvious Health Concerns


Age of Horse (estimate)

Breed of Horse (if known)

Photo(s) of Horse
General Attitude & Demeanor


Manure Amount
Manure Appearance
Urine Amount
Urine Appearance
Current Coggins?
Photo of current coggins

General Comments


Additional Information Regarding Rescue/Investigation

Please sign below that the information submitted is accurate to the best of your knowledge.
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.