Animal Bite Incident Report
Officer/Deputy Reporting *
Your answer
Officer/Deputy Phone Number
Your answer
Date of Incidient *
MM
/
DD
/
YYYY
Time of Incident *
Time
:
Victim's Name *
Your answer
Victim's Parent's Name
(if victim is a minor)
Your answer
Victim's Phone Number *
Your answer
Animal Owner's Name *
Your answer
Animal Owners Phone Number *
Your answer
Location of bite on victim's body *
Your answer
Did the victim present to the ER for treatment? *
Type of Animal Involved
Your answer
Animal Status *
Notes/comments
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms