Dangerous Dog Evaluation Form
Use this Dangerous Dog Evaluation Form to assess a dog's risk based on incident details and behavior history.
Owner's Full Name
*
First Name
Last Name
Owner's Contact Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Dog's Name or Identification
*
Dog's Breed
*
Dog's Age (years)
*
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
Incident Location (address or description)
*
Description of Dangerous Behavior Observed
*
Prior Bite or Aggression History
*
No known history
Previous bite(s)
Previous aggression (no bite)
Other
Current Containment or Security Measures
*
Evaluator’s Risk Assessment and Recommendation
*
Submit Evaluation
Should be Empty: