Dog Investigation Form

Complete this form to submit a Dog related complaint to Clackamas County.

Date of Occurrence mm/dd/yyyy
/ /

Time

What Occurred?

Where Did It Occur?

Type of Animal

Description of Animal

Current Location of Animal

Additional Information

Are You The
Victim Witness Standing By Owner

Name

Address

City

State

Zip Code 97045 / 97045-1234

Primary Phone ###-###-####

Secondary Phone ###-###-####

Is this a
Residence Business

Owner's Address (if same leave blank)

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

Time Biten

Date Bitten mm/dd/yyyy
/ /

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 another type of incident, skip otherwise

Injuries / Symptoms to animal that was attacked?