Survey - Incident Report (Non-Human Injury)

Incident Report (Non-Human Injury)

Please use this form to report any type of incident not related to human being bitten by an animal. To notify San Diego Humane Society Law Enforcement of an animal biting a human, please use this form.

To fill out the paper form, please print this PDF file.

Dog on dog attacks that occurred at a dog park, will be filed as information only. Dog parks are considered “use at your own risk.” If this incident occurred outside of a dog park, a Humane Law Enforcement officer may follow up to assess further.

Please provide your contact information:

This form was completed by:

Name:

First Required	Last Required

Email: Required

Street 1:

City/State/ZIP:

City	State	ZIP

Mobile Phone: Required

Date of Birth:

Yes, I would like to receive e-mail from San Diego Humane Society

Yes, I would like to receive postal mail from San Diego Humane Society

Question - Required - Which option best describes this incident?

Incident Information

Question - Required - Address / Location where incident occurred:

Question - Required - Time of incident:

Question - Not Required - Date of incident:

Month

Day

Year

Question - Required - If bitten, did the bite break skin?

Yes

Circumstance of Incident

Question - Required - Incident Details: Please describe what happened before, during and after the incident. Include as much detail as you can remember.

Animal Owner Information (if known)

Question - Not Required - Name:

Question - Not Required - Street:

Question - Not Required - City:

Question - Required - State:

Question - Required - Zip:

Question - Not Required - Dog Owner's Telephone Number:

Animal Description Information

Please describe the animal involved in the incident.

Question - Not Required - Type of Animal:

Question - Not Required - Breed of Animal:

Question - Not Required - Sex of Animal:

Male

Female

Question - Not Required - Animal Name:

Question - Not Required - Animal Color:

Question - Not Required - Animal Age:

* These fields are required to submit this form.

Incidents that do not have known animal owner information may limit the response a Humane Law Enforcement officer can take. If you obtain additional information after submitting this form, please call San Diego Humane Society's dispatch at 619-299-7012 (press 1).