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Health Care Provider ANIMAL BITE REPORT FORM Chautauqua County Health Department (716) 753-4481 FAX (716) 753-4344 Name of Healthcare Provider (Hospital, Practice, Agency) Date Person Bitten/Scratched

How to fill out animal bite report form

How to fill out an animal bite report form:

1. Start by providing your personal information. Fill out your full name, address, contact number, and any other requested details about yourself.
2. Next, provide information about the animal that bit you. Include the species, breed (if known), color, size, and any distinguishing features of the animal. If the owner's information is available, provide their name, address, and contact number too.
3. Describe the circumstances of the bite incident. Explain where and when it occurred, the nature of the interaction with the animal, and any other relevant details such as whether the animal was provoked or not.
4. Document any injuries sustained from the animal bite. Be sure to include the location of the bite, the severity of the injury, and any medical treatment received or required.
5. If there were any witnesses to the incident, provide their names and contact information. Witnesses can provide valuable testimony if further investigation is needed.
6. Indicate whether the animal has had a rabies vaccination or not. If known, provide the vaccination date and any associated paperwork.
7. Sign and date the animal bite report form to certify the accuracy of the information provided.

Who needs an animal bite report form?

1. Individuals who have been bitten or attacked by an animal and wish to report the incident and pursue necessary legal action if required.
2. Healthcare professionals and animal control agencies who handle and investigate cases of animal bites in order to track and monitor potential public health risks.
3. Authorities responsible for public safety and animal welfare who use the information from the report form to assess the need for further action such as quarantine of the animal, vaccination verification, or owner accountability.

For pdfFiller’s FAQs

What is animal bite report form?

Animal bite report form is a document that is used to record information about incidents where an animal has bitten a person.

Who is required to file animal bite report form?

Animal owners, animal control agencies, healthcare providers, and bite victims are required to file an animal bite report form.

How to fill out animal bite report form?

To fill out an animal bite report form, one must provide details such as the type of animal involved, the location of the bite, the severity of the injury, and contact information for all parties involved.

What is the purpose of animal bite report form?

The purpose of the animal bite report form is to track incidents of animal bites, monitor potential rabies exposure, and prevent the spread of diseases.

What information must be reported on animal bite report form?

Information that must be reported on an animal bite report form includes details about the animal, the circumstances of the bite, the location of the bite, the severity of the injury, and contact information for all parties involved.

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