Dog Investigation Form

Investigation Request Form

Date of Occurrence

Time

What Occurred?

Where Did It Occur?

Type Of Animal

Description

Animal's Current Location

Additional Information

Are You The
Victim Witness Standing By Owner

Name

Address

City

State
Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip Code

Primary Phone

Secondary Phone

Is this a:
Business Residence

Owner's Address(if same leave blank)

BITE INFORMATION - Fill out if Investigation Request is regarding a bite, skip otherwise

Date Bitten

Time Bitten

Was The Skin Broken?
Yes No

Medical Attention Received?
Yes No

If The Victim Is A Minor, Please List Their Guardians Name

Additional Information

CRUELTY INFORMATION: Fill out if Investigation Request is regarding cruelty, skip otherwise

Cruelty observed:

OTHER INCIDENT: Fill out if Investigation Request is regarding cruelty, skip otherwise

Injuries / Symptoms to animal that was attacked?