Human-Wildlife Incident Report Form
Please provide detailed information about the human-wildlife incident for accurate assessment and follow-up.
Date and Time of Incident
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident (address or nearest landmark)
*
Type of Wildlife Involved
*
Please Select
Bear
Deer
Coyote
Wolf
Mountain Lion
Fox
Raccoon
Bird of Prey
Other
Number of Animals Involved
*
Brief Description of the Incident
*
Were there any human injuries?
*
No injuries
Minor injuries (no medical attention needed)
Serious injuries (medical attention required)
Was there any property or livestock damage?
*
No damage
Property damage
Livestock/pet injury or loss
Immediate Actions Taken
*
Contacted authorities
Provided first aid
Secured area
No action taken
Other
Your Name
*
First Name
Last Name
Contact Email or Phone Number
*
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