Animal Bite/Incident Report Form

Report animal bites as required by law per NC General Statue 130A-184 through 201.

Rabies Risk Assessment and Treatment Steps

Managing Animal Bites, Rabies Exposures & Rabies Postexposure Prophylaxis (PEP):

Algorithms for Evaluating Human Rabies Risk from Animal Bites/Exposures: Domestic Dogs, Cats and Ferrets

Algorithms for Evaluating Human Rabies Risk from Animal Bites/Exposures: Bats and Wild Animals

This form must be completed by a health services worker.

Report Information

After the tenth phone digit, any additonal digits will format as extension: x99

Victim Information

(Required when age < 18)

Contact

Patient is Unsheltered/Homeless (if checked Address fields not required)
After the tenth phone digit, any additonal digits will format as extension: x99
After the tenth phone digit, any additonal digits will format as extension: x99

Td/Tdap

(Tetanus vaccine/booster)
Yes No

PEP

(Post-exposure prophylaxis)

Emergency Room Referral

Bite Information

Animal Control Notification

Tell us Who to Notify

*Required

City of Asheville Animal Control   

(Incident happened inside the Asheville city limits)

Buncombe County Animal Control   

(Incident happened outside the Asheville city limits)

Out of County   

(Incident happened outside of Buncombe County)
 
If you are unsure if the bite location is inside or outside of the Asheville city limits, you can verify the address here.

Animal Information

Attach Copy of Lab Results/Other Pertinent Records

   Delete

 

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Comments

Once you submit this information, you will be able to save a copy for your records.