Animal Welfare Incident or Complaint Form

ANIMAL WELFARE INCIDENT OR COMPLAINT FORM

Use the form below if you have a concern, complaint or inquiry regarding an observed animal welfare issue or incident. Your personal information is optional but is needed if you would like us to follow up with you regarding your concern.

Name

Provide your full legal name. If you wish to remain anonymous, leave blank.

Email Address

Provide your primary email address.

Phone Number

Provide your current primary phone number.

Date of observed incident or issue of concern.

Provide a specific date.

YYYY

Time of observed incident or issue of concern.

Provide a specific time.

Location of observed incident or issue of concern.

On-campus, off-campus, room number, etc. Please be as specific as possible.

Individuals involved at the time of observed incident or issue of concern.

Include names of faculty, student(s), potential witnesses or other individuals. Please be as specific as possible.

In what class did the observed incident or issue of concern take place?

If you do not know the specific class, insert N/A in this field.

What type of animal was involved in the observed incident or issue of concern.

Provide the type of animal or animals that you observed.

Provide any information that you may have on the animal involved in the observed incident or issue of concern.

Example: species, ID number, name, any specific injuries

Provide a detailed account of the incident including the reactions of the individual(s) and animal(s) involved and actions that were taken as a result of the incident.