Pitt County Forms Center

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   4550 County Home Rd. Greenville, NC 27858  |  Telephone: (252) 902-1725

   Pitt County Animal Services Bite Report Form
    

4. Reports need to be faxed to SECURE CD FAX LINE : 252-413-1446 Or call 252-902-2316 with questions.
6. Assigned Officer:
7. Date of Animal Bite*
   Date of Animal Bite
8. Date of Report:*
   Date of Report:
10. Victim Information
12. Last Name*
13. First Name*
15. Age*
16. Race:*
17. Sex

    1. Male
    2. Female
18. Is the victim underage?

    1. Yes
    2. No
20. Name of underage victim's parent, guardian, or legal custodian
22. Address*
24. City*
25. State*
26. Zip Code*
28. Phone Number*
29. Alternate Phone Number
31. Email Address
33. Parent/Guardian if Victim is Under 18
34. Primary or Attending Physician
36. Location & Description of Wound*
38. Animal Owner Information (If Known)
40. Last Name
41. First name
43. Address
45. City
46. State
47. Zip Code
49. Phone Number
50. Alternate Phone Number
52. Email Address
54. Animal Information
56. Was Animal Found?*

    1. Yes
    2. No
57. Was Animal Impounded?

    1. Yes
    2. No
58. ID #
59. Pen #
61. Was Animal Destroyed

    1. Yes
    2. No
62. Was Animal Sent To Lab?

    1. Yes
    2. No
63. Sex

    1. Male
    2. Female

    1. Neutered Male
    2. Spayed Female
65. Name (If Known)
66. Age
67. Species*
69. Breed
70. Color or Markings
72. Vaccination Current?

    1. Yes
    2. No
73. Vaccination Tag #
74. Date Given
    Date Given
75. Expiration
    Expiration
77. Veterinarian
79. Incident Information
81. Victim Notified
82. Owner Notified
83. Did Bite Occur On Owner's Property

    1. Yes
    2. No
85. Location Of Incident (If Bite Occurred Off Owner's Property)
87. Was Dog On A Leash?

    1. Yes
    2. No
88. If Yes: Length Of Leash

    1. Retractable
    2. 6 Foot or Less
    3. Longer Than 6 Foot
89. Was Dog Tethered

    1. Yes
    2. No
90. If Tethered: Type

    1. Rope
    2. Chain
    3. Cable
92. Additional Notes
Leave This Blank:


96. 1. Receive an email copy of this form.
97. Email address

    This field is not part of the form submission.

98. Submit Submit and Print

* indicates a required field