Submit Request

To submit a request fill in all the required information listed below. Mandatory fields are marked with an asterisk. Along with the mandatory fields you must select and provide a contact method to be contacted on.

Request Type Animal Requests - Report animal attack

Sub Category

Select Applicable Category*

Dog attack or harassment

Location Details

Search for property relating to the request. Select the location tab to search for a facility name.

Street Address

Please enter your street/unit number and street name only
eg. '2120 Albany Highway' or '1/35 Smith Street'.

If your address search returns no results, please contact the City of Gosnells on 9397 3000 for assistance.

Advanced Search

Unit number House number

Street name Suburb Postcode

Name Details

Enter your contact details.

Please select applicable

PersonBusiness

Title Given names* Surname*

Use the same address as above?

Street address.* Suburb Postcode Please enter at least one daytime contact number Home phone Work phone Mobile phone Email address

Notify By

Email
Phone
Mail

Request Description

Provide details for this request.

Description*

Additional Information

Please fill out the following additional information.

Date of attack*

Time of attack (HH:MM)?*

What or who did the dog attack?*

Breed of attacking dog?*

Colour of attacking dog?*

Size of attacking dog?*

Sex of attacking dog (if known)?

Name of attacking dog owner (if known)?

Was the owner in attendance at the attack?*

Were any physical injuries caused?*

Was medical or veterinary treatment required?*

Were there any witnesses?*

Are you prepared to give evidence if required?*

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Attachment Type

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File
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Submit the Request

Click submit to lodge this request. Once lodged you will receive an eRequest ID, which you can use as a reference

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