Barking Dog Complaint
1. Applicant details
Name:
Address
Contact Number
2. Dog Description
Address dog(s) Kept
Owners Name if Known
1st Breed of Dog Colour
2nd Breed of Dog Colour
3. Barking dog details
Describe the dog's barking and why it is a nuisance to you (use the checklist below to assist you)
How often does the dog bark?
How long does the barking continue for?
What sort of noise does the dog make?
Does it bark at certain times of the day?
Does it bark in response to passers-by or
other stimulus?
Where is the barking in relation to your property?
Does the barking interfere with any of your normal
activities?
Does the barking impact on your health or wellbeing?
How does the barking impact on other members of your
household?
Have attempts been made to approach the dog owner to discuss the matter?
Yes. How?
No. Why?
How long do you estimate that this problem has been going on for?
Are you willing to support Council? Yes No
Declaration
I hereby declare that all particulars given by me in this application are true and correct.
Signature
Date
Bark Record
NAME
..............................................................................................................
ADDRESS
..............................................................................................................
..............................................................................................................
ADDRESS OF DOG
Level of Nuisance
Please prioritise the following times showing which you consider to be the most annoying times the
dog barks:-
1 = High Level of Nuisance 2 = Medium Level of Nuisance 3 = Low Level of Nuisance
11.00 pm to 6.00 am 6.00 am to 7.00 pm
7.00 pm to 11.00 pm
Legend
Noise Level of
Barking
Cause of Barking (if known)
Action Taken by
Dog Owner
Nuisance Level
(according to times
indicated above)
Loud
Whining
Yapping
Muffled
Nothing
People Walking By
Bored
Owner Out
Territorial of Fence Boundary
None
Chastised
Put Dog Inside
High
Medium
Low
Please Note:
USE A NEW SHEET FOR EACH DAY
SIGN AND DATE EACH SHEET
BE ACCURATE AND PRECISE IN RECORDING TIMES
UNTIDY, DILAPIDATED OR ILLEGIBLE RECORD SHEETS WILL NOT BE ACCEPTED
Declaration
I hereby declare that all particulars given by me in this document are true and correct.
Signature Date
Level of Involvement - Are you prepared to attend a hearing as a witness on behalf of the
Masterton District Council in this matter?
Yes
No
(Any complainant who fails to attend a hearing after indicating that he/she would substantiate their
claim, no further action will be taken, and he/she maybe liable for all costs incurred by Council.)
1 of 7
MDC Bark record
Barking Times
Count the number of Barks (ie, llll)
(USE SAME WORDING AS IN LEGEND TO COMPLETE THIS SECTION)
Start/Finish
No. of Barks
Total No. of
Barks
Noise Level
Cause
Action
Signature: Date:
1
2 of 7
MDC Bark record
Barking Times
Count the number of Barks (ie, llll)
(USE SAME WORDING AS IN LEGEND TO COMPLETE THIS SECTION)
Start/Finish
No. of Barks
Total No. of
Barks
Noise Level
Cause
Action
Signature: Date:
2
3 of 7
MDC Bark record
Barking Times
Count the number of Barks (ie, llll)
(USE SAME WORDING AS IN LEGEND TO COMPLETE THIS SECTION)
Start/Finish
No. of Barks
Total No. of
Barks
Noise Level
Cause
Action
Signature: Date:
3
4 of 7
MDC Bark record
Barking Times
Count the number of Barks (ie, llll)
(USE SAME WORDING AS IN LEGEND TO COMPLETE THIS SECTION)
Start/Finish
No. of Barks
Total No. of
Barks
Noise Level
Cause
Action
Signature: Date:
4
5 of 7
MDC Bark record
Barking Times
Count the number of Barks (ie, llll)
(USE SAME WORDING AS IN LEGEND TO COMPLETE THIS SECTION)
Start/Finish
No. of Barks
Total No. of
Barks
Noise Level
Cause
Action
Signature: Date:
5
6 of 7
MDC Bark record
Barking Times
Count the number of Barks (ie, llll)
(USE SAME WORDING AS IN LEGEND TO COMPLETE THIS SECTION)
Start/Finish
No. of Barks
Total No. of
Barks
Noise Level
Cause
Action
Signature: Date:
6
7 of 7
MDC Bark record
Barking Times
Count the number of Barks (ie, llll)
(USE SAME WORDING AS IN LEGEND TO COMPLETE THIS SECTION)
Start/Finish
No. of Barks
Total No. of
Barks
Noise Level
Cause
Action
Signature: Date:
7
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