Incident form

Please complete this form with as much detail as possible and the include the chronology that led to a bite or other incident with a WAMAL dog. It will help us learn about the dog and develop a training/mitigation plan going forward. Thank you!

Contact Information

First Name*

Last Name*

Email*

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What type of incident was this?*

dog-to-dog	dog-to-human
human-to-dog	other

Date of incident*

Name of person reporting the incident*

Where did this happen?*

Mally Valley	Jee Jac
West Wind	Foster
Other

Did this involve medical attention for people?

Yes

If medical attention was provided, please describe. Include the location.

Name of dog*

Did this require vet attention for the dog(s)?

Yes

If vet attention was provided, please describe. Include the location.

If a bite occurred, using Dr. Ian Dunbar's Dog Bite Scale, what was the severity of the bite?

Level 1. Obnoxious or aggressive behavior but no skin-contact by teeth.	Level 2. Skin-contact by teeth but no skin-puncture. However, may be skin nicks (less than one tenth of an inch deep) and slight bleeding caused by forward or lateral movement of teeth against skin, but no vertical punctures.
Level 3. One to four punctures from a single bite with no puncture deeper than half the length of the dog's canine teeth. Maybe lacerations in a single direction, caused by victim pulling hand away, owner pulling dog away, or gravity (little dog jumps, bites, and drops to floor).	Level 4. One to four punctures from a single bite with at least one puncture deeper than half the length of the dog's canine teeth. May also have deep bruising around the wound (dog held on for N seconds and bore down) or lacerations in both directions (dog held on and shook its head from side to side).
Level 5. Multiple-bite incident with at least two Level 4 bites or multiple-attack incident with at least one Level 4 bite in each.	Level 6. Victim dead.

Name(s) of other people involved

Please provide a summary of the incident.*

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