animal bite report form

endstream endobj 14 0 obj <>stream a. Yes No Unknown Rabies PEP Administration DC Guidelines Flowchart (wildlife bites a person) 3. %%EOF Campbell, Monte Sereno, Mountain View and Santa Clara residents must report animal bites directly to SVACA at (408) 764-0344. Linn County Public Health has prepared the Animal-on-Animal Bite Report Form (PDF) that should be submitted to the Animal Control Agency. 1. Found inside – Page 14-43Whenever a dog - bite incident is reported , treatment room personnel will complete AF Form 1551 , “ Animal Bite Report ” , serially number it , and send ... Victim Information. "`ݔ�A��c8��z"�-ԫ(L;��ľ�9�ߕ݅��c�K�9ǪK�KE5�v��v��/j ��%2��k�> �*�!��l٭&�� a�ߧi��ᜠg�. All personal information you include in this form is confidential. ANIMAL INFORMATION. 4.a. ANIMAL BITE REPORT FORM Kentucky Department for Public Health 275 East Main Str. Rabies is spread by a bite or scratch from an infected mammal. Supervisor (or individual incident reported to) Name *. Sex: M F h޼�[o�0ǿ��[�$R�ĥ�H��IQR�h��$�ʷ�9v.�ݴ)2��!��H*�(*�kE\Ρ��RX��W Animal Encounter Report Form SG-58 REV. Get the THO Manual. c. 112 § 12z and 330 CMR 10.04, healthcare providers must report any bite by a domestic animal to a person within 24 hours, to the Animal Inspector* of the city or town where the bite occurred. Did the animal appear normal/healthy? Johnson County Animal Bite Report Form Form completed by: _____ Date: _____ ... or dies during confinement. Animal exposure reports can be made for any individual (e.g. Level 6. All people with knowledge of the bite should report the incident. Call 343-8119 to make a report. He has fallen in love – and it is not long until Sierva Maria joins him in his fevered misery. Unsettling and indelible, Of Love and Other Demons is an evocative, majestic tale of the most universal experiences known to woman and man. Contamination of open cuts or scratches with saliva of potentially rabid animals should also be washed off immediately. Animals. HOUR. Please review all fields before submitting. 2. patients, students not under care, employees, etc). Seek medical attention from a healthcare provider to assess your risk and discuss treatment options. Found inside – Page 411Every animal bitten does not necessarily develop the disease , but the ... However , a sharp line of distinction can not be drawn between these two forms of ... Animal Control Public Records Request Form. Report Animal Bites and Rabid Animals. Name of Bite Victim: Age: Gender: M F Parent or Guardian (if < 18 years old): Address County: City Zip Code: Bite Victim Details. Found inside – Page 5transmitting rabies ( e.g. , free - roaming period the animal is re ... were A new Army form , Report of have their immunizations ted cats or monkeys . Return Form to: Rhode Island Department of Health, Center for Acute Infectious Disease Epidemiology, Room 106, 3 Capitol Hill, Providence, RI 02908 or Fax to (401)-222-2477 or Phone report to (401)-222-2577, (401)-276-8046 after hours Revised April 2019 Bite Report If you are a clinician treating someone for an animal bite, please use this form to report the bite to Sonoma County Animal Services. Person Bit. The furious form of rabies is familiar to most people. If the owner is unknown, was the animal wearing a … CITY OF SAN ANTONIO ANIMAL BITE EXPOSURE REPORT 4710 State Hwy 151 San Antonio, Texas 78227 Office Phone- 210-207-6667, 210-207-6668/ Fax- 210-207-6678 The form may be submitted to Placer County Public Health via fax at 530-886-2945. The above list concerns unpleasant behavior and so, to add perspective: Levels I and 2 comprise well over 99% of dog incidents. Yes No Unknown. Animal Bite Report | Animal Welfare League of Arlington. Animal Control In the event of an emergency please call 9-1-1. " While Mutt enjoyed the array of unique animals he suddenly noticed that the barn was ablaze in the distance, and ran to the rescue. Read this delightful story to see who is named "Animal of the Year!" This report for is animal on human rabies exposure. If bitten by an owned animal, get the owner's address and telephone number. Many states require that animal control authorities be notified of animal bites. Found inside – Page 7All Los Angeles County Department of Public Health case reporting forms are available by ... www.lapublichealth.org/tb/forms/cmr.pdf Animal Bite Report Form ... Reporting ensures that a 10-day quarantine, when appropriate, can be initiated … PRESENT LOCATION OF ANIMAL Current: Report an Animal Bite. Was the victim attacked by surprise? After the bite. ANIMAL BITE REPORT FORM . Locally most reports come from animal control agencies, physicians, and veterinarians, but anyone may report a bite. Found inside – Page 1Given that a major factor in the low level of commitment to rabies control is a lack of accurate data on the true public health impact of the disease this report of a WHO Expert Consultation begins by providing new data on the estimated ... example@example.com . If you are bitten by an animal and the bite is serious enough to require medical attention you should go directly to a health care provider. sˡ��)�wX �J�I�b��m�ط8�z��(atO`kS��i��ycGq�m�4�bW��o��x��-��w��x~)V��+�/�v�t��IY��*��p�M��d��Q�jH1�;��sY$�H��j B�&��!=2� �H:ƩT��G��. h�b``��S�-*� b�yT@S8M�2��fx�+�A�!��'��"��>FK �%�dF��@C�� What: Report bites, scratches, or mucous membrane contact with animal saliva or brain material that could possibly transmit the rabies virus from any animal … The ordinance number is referenced and you may visit the Riverside County main site for an ordered list of ordinances if you prefer that format.. Reporting Bites by Domestic Animals. H��UMo�F��W̩X�z�I�'vjÒъEI��dJQI��;�]��-;-�H ��߼y��s �MrZ%'U�@Bu�H��~�I�;�u��!T��C�5y�f��43ܰ��[��pzQ��y5�7�S�%��_D��lVA�Y��U��$�&�w��C� 7��,�AV�2��]��m��i��f��f.9��p��C1��~6Y��(�~��N�~d�r�D��7��m�-�{�>��~ �uXt�M�zn=�m�f(�bw�C��iwa��]ݶ� e�Q&��/TB�I�K�iVm= dG��ݢ^#�z=��U�LJ��O��/lۡYR DATE/TIME OF INCIDENT. Apply an antiseptic to the wound. Most dog bites are mild, but many result in injuries and infections that need medical care. Iredell County Animal Bite Report Bites must be reported with 24 hours Please fax completed form to: 704 928-2015 AND call 704-878-5335 to Report the Bite For questions, call Animal Services and Control at 704 878- 5424 ext. Thank you for visiting the County of Fresno. It should be used by county health department staff when conducting an animal bite investigation. h�bbd```b``�"��rɒ &�A$�/0[��&o�E*�� `�H2�8�M["��9.&�-A ��T#�30j}0 7�3 Brucellosis 9. Found inside – Page 8The form included checkboxes for the animals * wild rats , 156 miscellaneous , 114 that most commonly bite squirrels , and 49 laboratory rodents . people ... Animal Bite / Rabies Exposure Report Form In New York State, health care providers are required to report any potential human rabies exposures to the local Health Department. To report an animal bite or scratch, please fill in the form below or call 311 or (210) 207-6000. For information on barking or loose dogs, or animal related problems and issues please visit the Ventura County Animal Services website at www.vcas.us or by calling them at (805) 388-4341. Rabies PEP Administration DC Guidelines Flowchart (domestic animal bites a person) 2. Animal bite # 4. Mail a completed copy to the Division of Vital Records. TYPE (Dog, cat, etc.) PATIENT DEMOGRAPHICS %%EOF 226 0 obj <>stream Please use the Alameda County Public Health Department Confidential Tuberculosis form when reporting a tuberculosis case or suspected case (mandatory reporting within one working day). Instructions for completing the form “Animal Bite Report” 6/07 The purpose of this form is to collect information about animal bites in the context of a rabies control investigation. Forms for Town Health Officers. Street No. How to report an animal bite? To report bites in Vernon, call the city Vernon and ask to speak to the Health Department: 323-583-8811. ?�Tt��{�'�yG�V��~� h�@ This includes all animals bites and scratches from both wild and domestic animals, regardless of … Adoptee's Application for Noncertified Copy of Original Birth Record. Healthcare Providers and Bite Reporting. Victim dead. 2020. Found inside – Page 3843Reg . , effective 27 Eirelimstances of biting theidentalHmprovoked - attack by a ... The prompt - reporting of animal bites to an animal control - agency is ... I, the undersigned owner or person having control of the animal described in this Animal Quarantine/Bite Report, received and understand the require-ments of this quarantine and will notify the PENINSULA HUMANE SOCIETY & SPCA immediately should the described animal become sick, injured, lost or die during the designated time period. CMR/B: Report Tuberculosis. Fax this report to the local health department immediately. Found inside – Page 208Among dogs about 40 per cent of the animals bitten develop the disease ... In the dumb form paralysis of the lower jaw and throat is characteristic . BREED b. Click on the form name to access the applicable form. Signs may include: Aggression; Loss of fear; Daytime activity by a nocturnal species Application for a Birth Certificate. Sacramento County ; 4290 Bradshaw Road 28. Appeal Request - Dangerous / Vicious Declaration. Address where Incident Occured Same as Victim Same as Animal Owner Address. It is estimated that approximately five million persons in the U.S. are bitten by dogs each year. Yes No Unknown. If you are not redirected please download directly from the link provided. Found inside – Page 8These communications should be documented on DD Form 2341 , Report of Animal Bite – Potential Rabies Exposure . This form is filled out for all animal bite ... 311 is available seven days a week from 7am-7pm and on holidays from 8am-5pm. Download Subsection: Animal Bites Page 5 of 14 Missouri Department of Health and Senior Services Communicable Disease Investigation Reference Manual Determination of Risk in Animal Bite/Injury Incidents • In an animal bite/injury incident, the animal … Supervisor Email *. Indiana Department of Health Animal Bites Report Form. Found inside – Page 151Reports of typical outbreaks have been given in previous reports and it ... When a dog begins to act strangely and to bite animals , he is promptly shot . The most potent risk factor for the development of rabies is a bite from an infected animal. People that live in an area, or travel to an area that has a large incidence for rabies, are at a high risk for acquiring rabies from a rabid animal. Handling certain wild animals such as bats or raccoons will put a person at a higher risk. Last Name. Botulism (all forms) # 8. Found inside – Page 24MAN BITES MAN SINUD 1 JO POSTAGE AUSSEEN IF MAIS UNITED STATES TILL ooCS ... to include a category for humans on the city's animal - bite - report form . GEOGRAPHIC ADDRESS WHERE INCIDENT OCCURRED. 1. Found inside – Page 376... and vaccine is throughout Phetchabun province , a specific reporting form for administered at one site on days 30 and 90. Intradermal animal bites was ... Animal Bites. If an animal broke skin by teeth or nails, then by law then this report must be filled out to the best of your ability. Fax a STI disease report form: 303-782-5393. For further information or to submit form via email, please call 530-889-7183 and ask to speak to the CalREDIE liaison. Official Indiana Animal Bites Report Indiana State Department of Health Sta t e Form 14072 (R3/4-04) VICTIM INFORMATION Last Name First Name Sex M F Person bitten County Victim Type (circle 2) Human Animal Juvenile Adult OWNER INFORMATION Parent if victim is a juvenile: If animal … Animal Services Forms Animal Services Fees Animal Complaint Form Instructions for Bite/Quarantine Report Request Public Information Request for Bite/Quarantine Report Thinking About Becoming a Volunteer Volunteer Application Redemption Policy Flyer Lost/Found Dog Report Lost/Found Cat Report Tips to Find Your Lost Dog Tips to Find Your Lost Cat Yolo County … Temporary Puppy-Kitten Application. Return Form to: Rhode Island Department of Health, Center for Acute Infectious Disease Epidemiology, Room 106, 3 Capitol Hill, Providence, RI 02908 or Fax to (401)-222-2477 or Phone report to (401)-222-2577, (401)-276-8046 after hours Revised April 2019 h�bbd``b`J~@�q3�`� $Xv�$>��s@�*�H��@��&F�� '~ �� Pet Fancier Application final. Pet Foster Application. * Indicates required fields. Exotic-Wild Permit. Animal exposure reports can be made for any individual (e.g. Found inside – Page 5transmitting rabies ( e.g. , free - roaming period the animal is re - examined by ... the remaining 10 percent were A new Army form , Report of have their ... HS2GWC Frankfort, KY 40621 EPID 270 – 8/2019 Kentucky Revised Statute (KRS) 258.065 requires reporting of animal bites by a provider within 12 hours/or next business day, of initial assessment. Street Address Line 2 . Animal Control Complaint Form. Found inside – Page 52In the and foxes ( Urocyon cinereoargenteus , the spinal cord and brain , producing dumb form of rabies , animals remain Vulpes vulpes ) are rabies ... The dog is certainly not dangerous and more likely to 3. If bitten by a squirrel or any other wild animal, victims must wash the wound thoroughly and keep it clean to ward off infection. At any sign of infection like redness, swollen bite site, itching, incessant pain, or pus, the wound must be taken to the hospital for evaluation. Report an Animal Bite. h�b``�b``Rf eT��, �b\P��cf��Ǘ6>�cݲ�� !j��` �"� Completing and faxing this form fulfills that obligation. All animal bite reports are to be called in and the physical form faxed to the police department in whose jurisdiction the victim lives. Health care providers should fill out the Bite Report Form (PDF) and fax it to 734-544-6706.. �p�{DF��>x�p�pJ8 0�|ԀWprsC��8��V��nVŕ�˘�n�H1�~"3�^��YE��"YU��:��:Y?W�>j+��(��%��װ��o� 4��"2��F�^��i��܌.j��q�ɲ��SM}��*��DJ:�_m,\�Y�7� ,��ɶ��S�� Q��X�R�Y��uU��*�%x��W�}?0�MaD�ȡ��ar�R�Y��m��"�zY��QR��9.�� Ȕ>ĵ�FM�F��^�*�,P��Ҡ��܏�:fɹ�%�6,9�`ɞz�o̅� � As directed by the animal bite investigator, I will then deliver this animal to a licensed veterinarian _____ _____ within 24 hours for a health check. Sex. Mail a completed copy to the Division of Vital Records. ANIMAL BITE REPORT RABIES CONTROL INVESTIGATION Date of Report: _____ 3. Found inside – Page 14-43Whenever a dog - bite incident is reported , treatment room personnel will complete AF Form 1551 , “ Animal Bite Report ” , serially number it , and send ... Statutes 26:4-82, 83, & 85, you are hereby ordered to confine the animal securely in a manner designated by the local health department until released by an agent of the local health department. Long Beach Department of Health and Human Services . County ordinances have been grouped below by subject for ease of use. If you find a bat in your house, please don't let it go until without talking to us. In case of bites from wild or stray animals, if it can be endstream endobj startxref Animal Disease Report Form : For PHYSICIANS, HOSPITALS, MEDICAL FACILITIES Animal-Bite-to-Human Report Form : For ANIMAL CONTROL AGENCIES. ANIMAL BITE REPORT FORM Incident Data: AM Location of incident:_____ Date of Bite: Time of Bite: PM On Owner’s Property? Found insideThe seventh edition of the Canadian Immunization Guide was developed by the National Advisory Committee on Immunization (NACI), with the support ofthe Immunization and Respiratory Infections Division, Public Health Agency of Canada, to ... If you would like to report an animal bite or scratch to Toronto Public Health, submit an Online Animal Exposure Report. Portage County Health District Animal Bite / Exposure Report Form 705 Oakwood Street, 2nd Floor, Ravenna, Ohio 44266 Complete as much information as possible. This grouping is called "Title 6". Write down a description of the animal, time and location of the incident and try to remember where the dog went (if it was not your own animal who inflicted the bite). Street Name. Below are the various forms that town health officers need. Administrative Citation Request for Supervisor Review. Breed and description of the animal (color, markings, long or short hair). . Have this information ready: How and where the bite occurred. Indicate the gender and whether or not the animal has been spayed or neutered. Adult HIV/AIDS Confidential Case Report; Animal Bites Report - State Form 14702 ; Babesiosis Case Investigation - State Form 52135 ; Blood or Body Fluid Exposure, Notification of - State Form 51467 ; Confidential Report of Communicable Diseases - State Form 43823 ; Hepatitis B and Delta Hepatitis Case Investigation - State Form 52587 Street ... Report taken by. Found inside – Page 573AUTH : NIAFU - 90-3 reports of food borne illness destroy after 1 year . investigation AUTH : N1 - AFU - 90-3 DD Form 2341 , Report of Animal original at ... Animal Control Bite Statement. �"�j��iG��T�Y�Q��4�@U��aj�o`~ϰ��-L��5\�N{��!�0{��0|g9�xQ �0��0*129��0�1�8� �. Last Name*. If you are experiencing a medical emergency, please call 911 or go to the nearest hospital. FAX to your local Health Department Animal Services Dispatch, 805-388-4341, Toll-Free: 1-888-223-PETS (7387), Email: info@vcas.us, FAX: 805-388-4393, endstream endobj startxref Immediately wash the bite or wound with soap and water for at least 15 minutes. @��,=�� "�x�j��' &@]�6@/6 ��0ʂ,`)P�ц� 0c�h�Lܿc��\��3g͞3u��J�*'M��?��ؤ��CWOߠ��ASK[��BUM]��$7/�@RJZ&3+;'5-=CVN^!1)9%6.>ATL\"2*:&4. Animal Bite Incident Report form Page 2 of 3 01/4/2010 . b. Animal bite reporting form. 22 0 obj <>/Filter/FlateDecode/ID[<43C7DF4ED78B46E902B683B9A8A2B69A><36FC2BABDE7EB349897977C55050A52A>]/Index[10 22]/Info 9 0 R/Length 70/Prev 13954/Root 11 0 R/Size 32/Type/XRef/W[1 2 1]>>stream Found inside – Page 7(2) The disposition of dead privately owned animals is the responsibility of the ... Department of Defense Form 2341 (Report of Animal Bite–Potential Rabies ... 195 0 obj <> endobj You must report any type of animal bite within 24 hours of the event. Application for a Birth Certificate with Fees Waived for an Individual Who is Experiencing Homelessness. Found inside – Page 51915 instances ( 3.2 percent ) , the presumed accidental bites were ... in 1976 of the revised animal bite report form , the reporting of animal bites was ... Animal Bite Report Form. 1. If “other”, write the type of animal in the space provided. Dog License Application All dogs four months and older must be licensed in Sonoma County. endstream endobj 196 0 obj <>/Metadata 3 0 R/Pages 193 0 R/StructTreeRoot 7 0 R/Type/Catalog>> endobj 197 0 obj <>/MediaBox[0 0 612 792]/Parent 193 0 R/Resources<>/Font<>/ProcSet[/PDF/Text/ImageB/ImageC/ImageI]/XObject<>>>/Rotate 0/StructParents 0/Tabs/S/Type/Page>> endobj 198 0 obj <>stream Date. # 7. Sacramento, CA 95827 Tel: 916 Application for a Birth Certificate with Fees Waived for an Individual Who is Experiencing Homelessness. ... such as Grifols at 1-800-243-4153 or Sanofi Pasteur at 1-800-822-2463 and complete the request form. Found inside – Page 336The bimonthly incidence of dog prefer cats or other small animals as pets . bites ... Special dog bite report forms were mailed to the hospitals within the ... h��1JA��{Y�0E�b�"N'Xx�@l��`��*M/!Xx{O�9�ؤLv~�'�V-R��x��3��옊t�D2O}��Ƙ�� r��o�w�{�!/6sC��W>.�4ͭK>��|D��#y �)��ni��_��B�� Animal Bite Report Form (* Required Fields) Person Reporting Information * First Name: * Last Name: * Phone: 555-555-5555: Are you the victim? 0 0 �J}��'�~�+�+�SZ��y��?/�G'r�}#��襹��?��c��k>��пsWR/.��\y�� C̷�y��b�ݾ��xN��=�cx�K.? There are 3 animal bite report forms: Human Bite, Wound of Known, and Wound of Unknown. Failure to … Animal Bite Investigations State laws and local ordinances require any person having knowledge or suspicion that an animal has bitten any person to immediately report it to animal control. Found inside – Page 19States participating in the program submit monthly summaries to the CDC on the following form Animal Bite Monthly Summary Form HSM 4.299 Exhibit 26 Data ... 0 10 0 obj <> endobj These ordinances apply to residents living in the unincorporated areas of Riverside County. Was the victim attempting to touch, feed, or pick up animal? Any adult may report an animal bite. Complete ANIMAL BITE REPORT FORM - Town Of Waitsfield, Vermont in just several minutes following the recommendations listed below: Find the template you will need in the library of legal forms. Click the Get form button to open it and move to editing. Physicians are required by state law to report animal bites to people. endstream endobj startxref - Month - Day Year. SEX c. DATE OF BIRTH (YYYYMMDD) b. All animal bites and exposures to bats should be reported to Washtenaw County Health Department. Adoptee's Application for Noncertified Copy of Original Birth Record. An unusual cluster of isolates 6. Found inside – Page 255The key to a successful control program rests on an adequate reporting system for all animal bites . Report form should be provided by the health department ... 384 0 obj <>/Filter/FlateDecode/ID[<2BDCC80A001651468BCD69618551A05C>]/Index[204 308]/Info 203 0 R/Length 292/Prev 1413259/Root 205 0 R/Size 512/Type/XRef/W[1 3 1]>>stream h�b``�c``�b```��Ā For additional information, the Town Health Officer Hotline is available Monday through Friday (except state holidays), 7:45 a.m. to 4:30 p.m. at 800-439-8550. Cancer ^ 11. Found insideThis book provides essential worldwide reference information regarding rabies for public health officials, veterinarians, physicians, virologists, epidemiologists, infectious disease specialists, laboratory diagnosticians, and wildlife ... Date/Time of Report: *. � ��@e$��J.0x"� E DESCRIPTION OF ANIMAL. 2127 Front Street ; Sacramento, CA 95818 . Notes: Yes No Unknown. %PDF-1.5 %�� Found inside – Page 208Among dogs about 40 per cent of the animals bitten develop the disease ... In the dumb form paralysis of the lower jaw and throat is characteristic . Children are more than twice as likely as adults to be victims of dog bites. Arboviruses (includes Colorado tick fever, Crimean-Congo hemorrhagic fever, dengue, Eastern equine encephalitis, St. Louis encephalitis, West Nile virus infection, Yellow fever, et al.) hޤ�mo�0��}�>P�%N"UHЖn��P��I�x)$(q��g� :��f��q��f� � @h,F=x� This Ordinance is the law in all municipalities within Cook County. Any municipality regardless of its population may pass an ordinance effective within its jurisdiction more strict than the County Ordinance. Found insideThe back side of the Animal Bite or Scratch Report form is for use by the Orange County Health Department Director of Veterinary Public Health ( County ... %%EOF Found inside – Page 208Among dogs about 40 per cent of the animals bitten develop the disease ... In the dumb form paralysis of the lower jaw and throat is characteristic . Each disease section includes: disease name, description of the clinical features of the disease, infectious agent, occurrence, disease reservoir, mode of transmission, incubation period, period of communicability, susceptibility and ... : Check the box next to the type of animal involved in the bite. When a person suffers an animal bite, scratch or saliva exposure, contact Charlotte-Mecklenburg Animal Care and Control to file a report (call 311 or fax the attached form to Charlotte-Mecklenburg Animal Care and Control FAX 704-336-5709). Was the attack provoked? Reporting Forms. Animal Bite Incident Report Form Date of Bite: ... (if victim is a minor or an animal) First Name Last Name . 0 PHONE: (330) 296-9919 FAX: (330) 297-3597 www.portagehealth.net FAX this completed report to (330) 298-4492 WITHIN 24 HOURS Name of person To report bites in Pasadena, call the Pasadena Humane Society at: 626-792-7151. Information on Animal Control and How to Report a Pothole can be found below. This form has been modified since it was saved. c. SIZE d. COLOR. If the animal remains healthy during this period, it did not transmit rabies at the time of the bite. If it is a routine dog or cat bite where the animal is healthy and is being quarantined under the guidance of animal control, you do not need to consult the Maricopa County Department of Public Health (MCDPH). endstream endobj 11 0 obj <> endobj 12 0 obj <> endobj 13 0 obj <>stream ��Y��3�_S��:liL�K^;0j[T�@�`bZ ��র20�pCm� ` %� 1 Found inside – Page 4DD Form bies specimens in CONUS will be made to the Army Veterinary 2341 ( Report of Animal Bite — Potential Rabies Exposure ) ( approved Laboratory ... Form Title: DHEC 1799 Animal Incident Report . It should be used by county health department staff when conducting an animal bite investigation. Dogs, cats, and ferrets that bite or scratch a person will be required to undergo quarantine for a period of 10 days. Animal Bite Reporting Form. Report the dog bite to animal control and the local health department. Call your local police department's non-emergency line. Report the incident to the police, and the police will dispatch animal control or an officer to come to the scene. ANIMAL BITE INVESTIGATION FORM . The appropriate animal bite form should be completed, then faxed to the OPH. Ventura County Animal Services. Please fill out this form to the best of your ability. Animal Bite Report Form-Owner Durham County Department of Public Health December 2012 Page 2 of 2 The animal must be confined immediately at the Animal Protection Society of Durham (Animal Shelter) regardless of a pending request for alternative confinement. Found inside – Page 84CONFIDENTIAL MORBIDITY REPORT FORM ACD 222 ( SEND TO LOCAL HEALTH OFFICER ) STATE OF CALIFORNIA ... Special report forms for animal bites are also common . Even if your state law does not require you to report animal bites, you may wish to call animal control to report the bite. If you have any questions completing this form, please PART I - ANIMAL BITE HISTORY (To be completed by Emergency Department or Primary Care Interviewer) 2. Name of Bite Victim (Last, First): 4. Forms. Complaint Statement To file an animal-related complaint please complete this statement. First Name. Was another animal present? Where does this animal spend most if its time? Call us at 734-544-6700. Instructions for completing the form “Animal Bite Report”, 6/07 The purpose of this form is to collect information about animal bites in the context of a rabies control investigation. Bite and Rabies Reporting Forms Suspected Rabid Animal - instructions and form Animal-Bite-to-Human Report Form Bat Submission Form Wild Mammal vs. CDC Guidelines for Treating Rabies Exposures in Humans 4. Victim Information. Parent/Guardian Phone Number ... Email . Yes No Unknown. If someone you know has been bitten or scratched by an animal, report it immediately using the Rabies Exposure & PEP Administration Report Form Breeder Show Application. The vast majority of animal bites in the United States are inflicted by dogs. To obtain information on a previously reported bite incident, you may call the Animal Care Service bite line at 207-6668. Your health care provider should fill out a bite report and fax to us at 248-858-5841. Forms. Application for a Birth Certificate. Animal Contact Incident Report - 1 Patient Per Form To be Completed by Health Care Provider; Not Patient *Notify Monroe County Department of Public Health of All Animal Bites / Contact incidents * Fax Report to 753-6014 Non-Routine Exposures: Bite or Contact with Saliva From Wildlife or Domestic Animal Not Vaccinated Against Rabies. All animal bites must be reported to the local Town Health Officer or other town official within 24 hours of actual or constructive notice by calling or faxing a completed Town Health Officer Animal Bite Report Form. Anthrax # 5. Confidential reporting form for sexually transmitted infections. This section requires that a report of an animal bite be made to the Health Commissioner of the jurisdiction where the bite occurred within 24 hours of the bite in the same manner as the reporting of class A diseases. Pursuant to M.G.L. First Name Last Name. Found inside – Page 813Other causes of idiopathic NS are several forms of glomerulonephritis and focal ... lithium, interferon, NSAIDs), insect stings, and venomous animal bites. �r2ݫ��n��\�Rr��р3F&Y��@p��x\�,�t8�n�M��t��ӨL�쳵`"twA_l�L��(��^��R�R�sX�._�4ߐ�4�U��'iY�mR6�r�+�3|Kj�I?��Ƽ|V��)�z��Ղ�z��B+�%��@�@2�Ɂ{��ZCk=�=�a��)D��1��+v�:J�7�a�v�GK?��F��dQ�Q�P�A}�P޻�zG��_S�W��־��U��F�!Ӈ��ꉸ��{�ב��p�� #��v��(}X=�|��j�_x��&~��c;i}��/��4��ç� /��.O7�� R�a�:�� 7&@ If an animal scratches or bites another animal and/or person, the incident must be reported due to the OPH's Rabies Prevention Program. Case Investigator: Date of Report: SECTION A: Bite Victim Information . Incident Information . These confinement periods will be determined by FDOH. Department where the bite victim and the physical form faxed to the OPH rabies... Form form completed by emergency department or Primary care Interviewer ) 2 may be submitted the. Report and fax it to 734-544-6706 contact Phone #: I is an emergency please call 530-889-7183 and to! Complaint Statement to file an animal-related complaint please complete this Statement dispatch animal Control and How report. Anyone may report a Pothole can be confined for a 14-day observation.! Also be washed off immediately if “ other ”, write the type of animal in the unincorporated of... Information about the bite Occurred and complete the request form to act strangely to. ) 207-6000 reported due to the County health department where the bite should report the incident to the nearest.! Discuss treatment options year, United States are inflicted by dogs ( e.g week from 7am-7pm on! Previous reports and it officer to come to the police, and ferrets that bite or scratch a ). Of Birth ( YYYYMMDD ) b human bite, Wound of Known, and Wound of Known, ferrets. The local health department immediately an individual Who is Experiencing Homelessness you: has been modified since was... Telephone number within 24 hours of the bite report forms: human bite, Wound of Known, and,... If “ other ”, write the type of animal involved in the dumb form paralysis the! Via email, please fill out the bite Occurred of police Car Crash or Equipment Loss person the! ; Loss of fear ; Daytime activity by a small to detect care and Control for... The city Vernon and ask to speak to the police will dispatch animal Control an! On animal Control AGENCIES Control officer will be required to undergo quarantine for a Birth Certificate Fees. Aggression ; Loss of fear ; Daytime activity by a nocturnal species after the victim! Medical and law enforcement reasons of attack a. type ( dog, cat, etc. completed... Button to open it and move to editing Equipment Loss rabies PEP Administration DC Guidelines Flowchart ( bites... Form may be submitted to Placer County Public health via fax at.... Reporting animal bite report form incident dog License Application all dogs four months and older must be reported to the County residence! Dog License Application all dogs four months and older must be licensed in Sonoma County appropriate animal report...: How and where the bite victim and the local health department prepared the Animal-on-Animal bite report but the form! Have any animal bite report form, please fill out this form is submitted, an animal bite report:! Control officer will be required to undergo quarantine for a Birth Certificate with Fees Waived for an Who! How and where the bite victim lives dispatch centers, a representative animal! ( 210 ) 207-6000, fax: 805-388-4393, animal bite report form submit form via email, call... A period of 10 days information Exchange form animal that bit you: has been properly vaccinated by! 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