Rangers - Dog Attack Statement - Witness

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Introduction
What we need to know
Details of the incident - Part A
Details of the incident - Part B
Details of the incident - Part C
Details of the incident - Part D
Declaration
Submit Response

Introduction

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Do you speak and understand English?*

YesNo

Are you affected by alcohol or any drugs?*

YesNo

Would you be willing to attend court to give evidence?*

YesNo

Personal information

Personal information

First name*

Last name*

Date of birth*

Gender*

MaleFemale

Contact details

Contact details

Current residential address

Street Address:*

City:*

State:*

Post Code:*

Country:*

Contact number*

Email*

Details of the incident - Part A

Date of the incident*

Location of the incident*

Approximate time of the incident*

Details of the incident - Part B

The dog/s involved in the attack is/are described as follows:

Gender of the dog

MaleFemaleUnknown

Breed of the dog (if known)

Colour of the dog (if known)

I can identify the attacking dog/s?*

YesNo

The attacking dog/s owner at the time of the attack was:*

I can identify the attacking dog/s owner?*

YesNo

Details of the incident - Part C

The victim animal/person involved in the attack is/are described as follows:*

Were there any other persons/animals involved in the attack?*

YesNo

If yes, provide details below

Prior to the attack:*

During the attack:*

After the attack:*

Further details I wish to disclose regarding the attack are:

Details of the incident - Part D

If you saw the attack, please sketch the locality of the attack/include street name and house number, verge/footpath. Please attach below

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Declaration

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