Title Page
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Location:
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Location
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Document No.
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Patrol Date/Time
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Patrol Conducted By:
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Additional Personnel in Attendance
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Animals located/impounded?
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Offending animal details;
Offending Animal
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Age of Animal:
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Sex of Animal:
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Primary Breed:
- American Staffordshire Terrier
- Beagle
- Border Collie
- Boxer
- Bull Arab
- Bull Mastiff
- Cattle Dog
- Chihuahua
- Crossbreed
- Fox Terrier
- German Shepherd
- Golden Retriever
- Great Dane
- Irish Wolfhound
- Jack Russell Terrier
- Kelpie
- Labrador
- Maltese Terrier
- Poodle
- Rhodesian Ridgeback
- Rottweiler
- Shar-Pei
- Shih Tzu
- Siberian Husky
- Staffordshire Bull Terrier
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Secondary Breed:
- American Staffordshire Terrier
- Beagle
- Border Collie
- Boxer
- Bull Arab
- Bull Mastiff
- Cattle Dog
- Chihuahua
- Crossbreed
- Fox Terrier
- German Shepherd
- Golden Retriever
- Great Dane
- Irish Wolfhound
- Jack Russell Terrier
- Kelpie
- Labrador
- Maltese Terrier
- Poodle
- Rhodesian Ridgeback
- Rottweiler
- Shar-Pei
- Shih Tzu
- Siberian Husky
- Staffordshire Bull Terrier
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Primary Colour:
- Ash
- Beige
- Black
- Blue
- Brindle
- Brown
- Caramel
- Champagne
- Chocolate
- Cream
- Fawn
- Ginger
- Golden
- Grey
- Harlequin
- Honey
- Merle
- Red
- Roan
- Sable
- Silver
- Tan
- Tri
- Wheaten
- White
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Secondary Colour:
- Ash
- Beige
- Black
- Blue
- Brindle
- Brown
- Caramel
- Champagne
- Chocolate
- Cream
- Fawn
- Ginger
- Golden
- Grey
- Harlequin
- Honey
- Merle
- Red
- Roan
- Sable
- Silver
- Tan
- Tri
- Wheaten
- White
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Animal's name (if known):
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Is the animal wearing a registration tag or I.D.?
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Registration Tag/I.D. Number:
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Add media
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Is the animal microchipped?
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Microchip number:
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Add media
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Are the tag/I.D. number or microchip details current?
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Is the animal registered?
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Has the owner/responsible persons had the animal more than 14 days?
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How long?
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Owner/responsible person's name:
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Owner/responsible person's address:
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Add location
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Owner/responsible person's phone number:
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Impound Number:
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Photo of offending animal:
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Was the animal returned home?
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Are any conditions applied to the animal?
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Is the animal aggressive?
- No
- Yes - Human Aggressive
- Yes - Animal Aggressive
- Unknown
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Is there further action required?
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What further actions are required?
- PINs to be issued
- Verbal Warning Issued
- Compliance Notice Required
- Enclosure Inspection Required
- Other (please list)
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List other actions required:
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Follow up action due date:
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Attach additional evidence photos:
