Bite Severity Form
To be filled out only by EHS medical personnel using Ian Dunbar Canine Bite Levels for Reference
Unique ID
Name
*
First Name
Last Name
Title
*
Type of Bite
*
Injury to Individual
Injury to Animal
Both
Ian Dunbar Canine Bite Levels (injury to Human)
*
Level 1: Air Snap, No Contact
Level 2: Tooth Contact, Bruising, No Puncture
Level 3: Puncture, depth shallower than ½ length of canine tooth, tooth scrape
Level 4: Puncture, depth deeper than ½ the length of canine tooth, may be laceration
Level 5: Multiple Punctures, deeper than length of canine tooth, multiple lacerations
Level: 6: Person(s)/ animal(s) perish
Ian Dunbar Canine Bite Levels (injury to Animal)
*
Level 1: Air Snap, No Contact
Level 2: Tooth Contact, Bruising, No Puncture
Level 3: Puncture, depth shallower than ½ length of canine tooth, tooth scrape
Level 4: Puncture, depth deeper than ½ the length of canine tooth, may be laceration
Level 5: Multiple Punctures, deeper than length of canine tooth, multiple lacerations
Level: 6: Person(s)/ animal(s) perish
Was Animal 2 (Aggressor) bitten?
*
Yes
No
Ian Dunbar Canine Bite Levels (Animal 2)
Level 1: Air Snap, No Contact
Level 2: Tooth Contact, Bruising, No Puncture
Level 3: Puncture, depth shallower than ½ length of canine tooth, tooth scrape
Level 4: Puncture, depth deeper than ½ the length of canine tooth, may be laceration
Level 5: Multiple Punctures, deeper than length of canine tooth, multiple lacerations
Level: 6: Person(s)/ animal(s) perish
Signature: I declare that theinformation, provided on this report, is accurate and true.
Date
-
Month
-
Day
Year
Date
Submit
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