Incident Report Form

Complete this form for any incident involving physical harm to a dog, person, or rat at a Happy Ratters trial. You can also download a printable PDF version of this form if you'd rather fill it out by hand. If the situation is urgent, call Jean MacKenzie at 603-724-8745 or Barb Burri at 603-397-2542 immediately — use this form to file the written report afterward. Please be as detailed as possible; our team reviews every report.

Fields marked * are required.

Trial and Host Information

Hosting Club * Please enter the hosting club.

Host Contact — Name * Please enter the host contact's name.

Host Contact — Phone * Please enter the host contact's phone number.

Host Contact — Email * Please enter the host contact's email so we can follow up.

Time, Date, and Location of Incident * Please enter the time, date, and location of the incident.

What happened? *

A dog injured another dog A dog injured a person Rat injury or death

Please choose which situation you're reporting.

Handler and Dog Involved

Handler/Owner — Name * Please enter the handler/owner's name.

Handler/Owner — Phone

Handler/Owner — Email Please enter a valid email address.

Dog HR Number

Dog Name

Dog Breed

Injured Dog

Injured Dog — Name * Please enter the injured dog's name.

Injured Dog — Breed

Injured Person

Injured Person — Name * Please enter the injured person's name.

Injured Person — Address

Injured Person — Phone

Injured Person — Email Please enter a valid email address.

Rat Incident Details

Class or game being run at the time * Please enter the class or game being run.

Dog involved, if any (name and HR number)

Contributing conditions (heat or cold, equipment, handling, etc.)

Incident Details

Description of Incident * Please describe the incident.Please be very detailed — a full account of the circumstances.

Witnesses to Incident — names, phone, email Include statements if witnesses are willing.

Was treatment procured? Please explain.

Would you like to attach photos, witness statements, or other documentation?

No Yes

Attach files *

Images (JPG, PNG, GIF, WEBP) or PDFs — up to 5MB each, 5 files max.

Please attach at least one file, or switch back to "No" above.

Signature and Submission

Host Signature (type your full name) * Please type your full name to sign this report.

Date * Please enter the date.

Leave this field blank

Submit Report →