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TLCHD Animal Bite / Scratch Reporting Form

Anyone may use this form to report an animal bite / scratch or a bat exposure and related injuries to the Toledo-Lucas County Health Department.

This form is used to report animal bites / scratches / bat exposure and related injuries to the Toledo-Lucas County Health Department.
Please complete as much of this form as possible.
1. Incident / Patient Information *This question is required.
Reported by:
e.g. 4192134100 ext 4
e.g. 01/01/2024 This question requires a valid date format of MM/DD/YYYY.
calendar
Patient Sex
e.g. 12, 28, 65 This question requires a valid number format.
2. Patient Address
e.g. Apt 2B
e.g. 4192134100
For a copy of this report This question requires a valid email address.
5. Incident Location and Treatment Information:
e.g. 123 Healthy Lane or Dog Park on Main Street, etc.
6. Animal Information:
Type of Animal *This question is required.
Was the animal a family pet in the victim's house/property? *This question is required.
Breed / Color
Was more than one animal involved in the incident? *This question is required.
  • Number and type of animals (e.g. breaking up dog fight, pet with bat etc.)
  • Any details about animals involved (e.g. behavior, interactions, etc.)
Description of animal contact with patient: *This question is required.Check all that apply
e.g. bite puncture on left forearm, scratches on right side of face/neck, etc.
Since you indicated more than one animal was involved, answer the following for the animal that bit/scratched the patient:
7. Additional Animal Information
Sex of Animal *This question is required.
Is the Animal Spayed / Neutered? *This question is required.
Has the Animal been Vaccinated for Rabies? *This question is required.
This question requires a valid number format.
Was the Animal Surrendered? *This question is required.
Quarantine Location: *This question is required.
Will you be submitting the bat to the Health Department to be tested for rabies?
BEFORE bringing a bat into the Health Department notify the Environmental Health Department by calling 419-213-4100 Option 4.
8. Fill out all information known about the Owner:
e.g. 4192134100
e.g. Apt 2B
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