Fillable Animal Injury Report Southeastern Louisiana University

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Animal Injury Report Southeastern Louisiana University

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The Animal Injury Report Southeastern Louisiana University form is 1 page long and contains:

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Country of origin: US
File type: PDF

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Implemented 7-30-08
Ver. 1
Southeastern Louisiana University
Animal Injury Report Form
Name of injured animal user:
Date of injury:
Time of injury:
Location of incident:
Nature of the injury:
Did the injury include a bite by an animal? Yes No
Did the injury result from a puncture wound from a sharp object, such as a
needle, piece of glass, or other sharp object? Yes No
If yes, please explain:
Did the injury require medical treatment? Yes No
If yes, provide address of medical facility.
Contact information for physician or other medical person involved in treatment
of injury.
I have notified my immediate supervisor: Yes No
I have notified my department head: Yes No
I have contacted campus police Yes No
Signature of Injured Individual Date
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Animal Injury Report Southeastern Louisiana University

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Completed 20 November 2019

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