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

Required if not notified
If bite occurred INSIDE Asheville City Limits contact:
Asheville Police Department Animal Control
(828) 252-1110
If bite occurred OUTSIDE Asheville City Limits contact:
Buncombe County Sheriff Dept. Animal Control
(828) 250-6670

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

Animal Information

Attach Copy of Lab Results/Other Pertinent Records

   Delete

 

Add another file

Comments

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