Bite Report — Human

Use this form to report a bite incident involving a dog in RMGDRI's care. All fields marked with * are required.

A board member will review your submission. If you have an emergency, please contact 911 or your local Animal Control immediately.

Reporter Information

Foster/Owner or Shelter/Rescue Representative's Full Name*

Your relation to Dog (i.e. owner, foster, etc.)*

Dog & Incident Details

Date of Bite Incident*

Dog's Name*

Dane-ID (e.g. 2026-001)*

Dog's Markings/Color*

Dog's Age

Name of RMGDRI Board Member Contacted, if any

Bite Details

Please describe bite/attack as clearly and objectively as possible*

Who was bitten?*

If the bitten person was not the foster/owner or the foster/owner's child, please provide the name and contact information for that individual

Medical & Follow-Up

Was medical attention recommended or required as a result of the bite?*

YesNo

If yes, please explain the medical treatment required

Required if medical attention was recommended or required.

Please upload pictures of the injuries sustained from the bite, if available

Upload up to 3 photos of the injuries (optional)

Click or drag photos here (3 remaining)JPEG, PNG, WebP, GIF, HEIC • Max 10 MB each

If a behavioralist was consulted, what is the name of the behavioralist, the date of consult, and the outcome of the consult?

Was Animal Control notified and if so, what county/city and state*

Certification & Signature

By signing below, I state that I have given the full and complete details of the bite incident that occurred and I am not withholding any information.

I certify that I have given the full and complete details of the bite incident and am not withholding any information

Signature*

Name of the person completing this form*

Email of person filling out the form*

Date Signed*