Bite/Scratch Report
Please complete the yellow shaded areas of this form and submit.  If you have any questions, please contact Curricular Support at csteam@ucdavis.edu.
Name
Email
Employee/Student ID
Date of Birth
Phone
Cell
Address
City
State
Postal Code
Student/Staff
Date of Injury
Explain the circumstances under which the bite/scratch occurred. Include animal type, site injured, and the location/building where injury occurred.
Status
Species
Breed
Age
Sex
Other
Color/Description
Rabies Vaccination
Vaccination Date
Serial #
Manufacturer
License#/Jurisdiction
Patient Number
Microchip #
Did the animal appear ill or injured?
Please describe the illness or injury.  2000 characters maximum. Please include any witnesses and their contact information.
Current Location
Future Location
Name of PI
Phone
Protocol # (Research/Teaching)
Shelter Agency
Shelter Contact
Shelter Phone
Date Discharged from UCD
Owner/Foster Name
Owner/Foster Address
City
State
Postal Code
Owner/Foster Phone
First Aid Provided?
Please describe the first aid provided.
Medical Care Provider
Medical Care Provider Address
City
State
Postal Code
Phone
Please provide supervisor or other contact information for follow-up questions on injury or animal location.
Name
Address
City
State
Postal Code
Phone
Title
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