300.10 written statement form and sworn statement regarding a possible potentially dangerous or vicious dog

1. Number: 300.10
SUBJECT: WRITTEN STATEMENT FORM & SWORN STATEMENT
REGARDING A POSSIBLE POTENTIALLY DANGEROUS OR
VICIOUS DOG
Page: 1
Date: 8/7/91
Approved: Ryan Drabek, Director Revised:
4/2/13
I. PURPOSE
To establish a uniform procedure for the completion of a written statement concerning
incidents subject to investigation by personnel of OC Animal Care.
II. POLICY
Written statements are to be used to declare witness to various incidents or complaints.
III. SCOPE
Applicable to all personnel.
IV. FORMS
Written Statement Form
Written Statement Form Instructions
Sworn Statement Regarding a Possible Potentially Dangerous or Vicious Dog
Sworn Statement Regarding a Possible Potentially Dangerous or Vicious Dog Instructions
V. DEFINITIONS
Not applicable.
VI. REFERRENCES
Not applicable.
VII. PROCEDURE
A. A Written Statement Form is used to declare witness to the following:
1. Criminal complaints.
2. Violations of County and State laws relating to animal issues.
3. Incidents involving members of OC Animal Care.

2. Number: 300.10
SUBJECT: WRITTEN STATEMENT FORM & SWORN STATEMENT
REGARDING A POSSIBLE POTENTIALLY DANGEROUS OR
VICIOUS DOG
Page: 2
Date: 8/7/91
Approved: Ryan Drabek, Director Revised:
4/2/13
B. A Written Statement Form must contain all necessary information and be stated in an
orderly and chronological manner. All statements must be true and correct and signed
as such by the person making the statement. The Written Statement Form will be
completed as follows:
1. The person completing the form will list their full name here.
2. The person completing the form will list their full address here, including street
address, city, state and zip code..
3. A detailed account of what happened shall be entered in this space including the
full names and addresses of persons or suspects involved and full descriptions of
any animals involved. If the statement is lacking this information or fails to
fully articulate the event, the form is to be returned to the person completing it
for clarification.
4. For record keeping purposes, the number of pages being submitted is to be noted
here.
5. The signature of the person completing the form is to be entered here
6. The date the form was signed is to be entered here.
7. A contact phone number is to be entered here in the event clarification is
necessary.
8. An alternate phone number is to be entered here.
9. If a Chameleon Activity number has been assigned to the incident upon the form
being requested, the person mailing the form is to note the Activity Number
here. If a Chameleon Activity Number has not been assigned, it will be added
by the Operations Desk Sergeant upon receipt.
10. The date the form is received by the Operations Desk Sergeant or Supervisor is
to be noted here.
NOTE: A Written Statement Form Instructions sheet is to accompany the Written
Statement Form when provided to the public.
C. A Sworn Statement Regarding a Possible Potentially Dangerous or Vicious Dog Form
must contain all necessary information, stated in an orderly and chronological manner.
All statements will be true and correct and contain detailed information specific to the
incident. Statements should describe the animal(s) behavior at the time of the incident
(i.e. The dog charged me barking and barring teeth). The form should also include any
defensive actions taken by a person to prevent bodily injury to themselve’s, another or

3. Number: 300.10
SUBJECT: WRITTEN STATEMENT FORM & SWORN STATEMENT
REGARDING A POSSIBLE POTENTIALLY DANGEROUS OR
VICIOUS DOG
Page: 3
Date: 8/7/91
Approved: Ryan Drabek, Director Revised:
4/2/13
another animal. Incomplete statements are to be returned to the person completing them
for clarification. The Sworn Statement Regarding a Possible Potentially Dangerous or
Vicious Dog Form will be completed as follows:
1. Activity Number.
2 Circle the corresponding letter that applies to the situation(s).
3. A detailed account of what happened.
4. The date of the incident.
5. The time of the incident.
6. Full name of victim(s).
7. Location of incident (address, if known).
8. Complete description of animal(s) involved.
9. Full name of dog owner.
10. Residence address of dog owner.
11. Phone number of dog owner.
12. Total number of pages submitted by declarer.
13. Printed name of declarer.
14. Legal signature of declarer.
15. Date declarer signed.
16. Residence address of declarer.
17. Home or business telephone number (include area code) of declarer.
18. Driver License or Identification number.
The Sworn Statement Form Instructions sheet is to accompany the Sworn Statement
Form when provided to the public.
D. Routing
1. Statements Forms received that are to be used in support of a criminal complaint
are routed to the Operations Desk to be included in the criminal complaint file as
evidence.
2. Statement Forms providing information relating to a Field Service enforcement
action are routed to the Operations Desk to be included in the appropriate
investigation file if one has been assigned, or to be attached to an
activity/investigation report for future reference.

4. Number: 300.10
SUBJECT: WRITTEN STATEMENT FORM & SWORN STATEMENT
REGARDING A POSSIBLE POTENTIALLY DANGEROUS OR
VICIOUS DOG
Page: 4
Date: 8/7/91
Approved: Ryan Drabek, Director Revised:
4/2/13
3. Miscellaneous Statement Forms referring to incidents involving OC Animal
Care personnel are routed to the appropriate section supervisor for action or
future reference.