Dog Bite Form

Dog Bite Form. If there was no bite, write “none” in the person bitten section. Person bitten victim name (last and first) date of birth address (number, street, city and zip) victim phone number reported by:

Fillable State Form 14072 Official Indiana Animal Bites from www.formsbank.com

Free preview dog bite form. A dog bite can cause tetanus bacteria to enter the body. Use this form, or one like it, to provide pertinent information to the animal inspector of the city or town where the bite occurred.

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Enter the animal owner’s address, including number and street, city, state, and zip code. Fax to your local health department

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Description dog bite form michigan. Form should be placed on desk in club office or if office is closed, under the door of the office.

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Muscle spasms, usually in the stomach; But after that, it’s presumed that you are aware of the incident and aware of the “vicious propensity” of your dog.

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Exclusions and coverage i personal and advertising injury liability, 2. Additional reporting forms can be found at www.bphc.org.) male female black white hispanic american indian/alaskan native asian/pacific islander other:_____

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Muscle spasms, usually in the stomach; Pe number:hon parent or guardian (if applicable):

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All such incidents are required by law to This form is to be used by medical care personnel and police departments, to report an incident where a person is bitten, scratched or has high risk contact with an animal.

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This form is to be used by medical care personnel and police departments, to report an incident where a person is bitten, scratched or has high risk contact with an animal. Quarantine periods for dogs and cats are a minimum of 10 days.

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You are not liable for the first bite that your dog inflicts on someone. Person bitten victim name (last and first) date of birth address (number, street, city and zip) victim phone number reported by:

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The signature wizard will enable you to insert your electronic. Instructions for the completion of the “animal bite, scratch, contact” form.

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If there was no bite, write “none” in the person bitten section. Person bitten victim name (last and first) date of birth address (number, street, city and zip) victim phone number reported by:

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Animal and owner information (provide as much information as known) type of animal: Exclusions are amended and the following added:

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Email or fax completed form to: Fax to your local health department

Date Of Bite / Exposure:

Fill in all the requested boxes (they are marked in yellow). If “other”, write the type of animal in the space provided. Animal bite report form incident data:

Description Dog Bite Form Michigan.

Pe number:hon parent or guardian (if applicable): Most reported bites are inflicted by dogs and cats. If “other”, write the type of animal in the space provided.

If The Animal Is Located, It Is Evaluated For Rabies Either By A Quarantine And Observation Period, Or By Testing Its Body After Death.

This form is to be completed within 24 hours of bite incident important: Did the animal appear normal/healthy? All such incidents are required by law to

As Directed By The Animal Bite Investigator, I Will Then Deliver This Animal To A Licensed Veterinarian _______ _____________________________________ Within 24 Hours For A Health Check.

Home / hospital / deceased / shipped to rabies lab. Fax to your local health department Fill out dog bite incident report form within a few moments by following the recommendations below:

_____ Date Released Released By Fra Result_____ Fra Test Date _____ Ph Staff Initials_____

Use this form, or one like it, to provide pertinent information to the animal inspector of the city or town where the bite occurred. This form is to be used by medical care personnel and police departments, to report an incident where a person is bitten, scratched or has high risk contact with an animal. Normally used in conjunction with settlement of a lawsuit.