Dog/Animal Incident Statement Form

Please report issues with dogs in your neighbourhood by completing the form below.

Dog/Animal Incident Statement Form
Complainant Details
Address
Address
City
Province
Postal Code
Sex:
Spayed/Neutered?
Alleged Offender & Dog Details
Address
Address
City
Province
Postal Code
Is this individual known to you?
Would you recognize them again?
Vehicle Info:
Alleged offending dog information
Sex:
Spayed/Neutered
Details of Incident
Who was involved?
Time
Was your dog on leash?
Was the other dog on leash?
Was the incident location designated as:
Was anyone else (person or animal) involved or injured, please describe:
Time treatment received:
Vet/Hospital reports taken?
Has this been reported to RCMP?
Were photos taken of injuries?
Were there witnesses?
Are they willing to provide a statement?
Address
Address
City
Province
Postal Code
Address
Address
City
Province
Postal Code
(In your own words and with extreme detail, please tell us what you personally observed and experienced. Include specific details of your observations and alt conversations. Continue statement on additional pages if required)

The City of Port Coquitlam is permitted to collect the information on this form under section 26(c) of the Freedom of Information and Protection of Privacy Act to administer your complaint. If you have any questions or concerns about this collection, please contact the City’s FOIPPA Administrator at 604-927-5250 or at corporateoffice@portcoquitlam.ca.