Dog Attack Incident Report

Your name *

Your address

Street address

Town

State

Postcode

Phone *

Email Address *

Date of incident

Time of incident

Breed and description of dog(s)(small/med/large, colour, long haired/short haired, shape)

Was the owner in attendance when the incident occurred?

YesNo

Was owner notified of the incident?

YesNo

Owner and/or dog(s) details (if known)

Street address

Town

State

Postcode

Describe the attack