Online Form - 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

First name *

Last name *

Date of birth *

Gender *

MaleFemale

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

Find by Street Address:

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

MaleFemale

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

Maximum size of ALL attachments is 976.56 MB

Declaration

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