Your Information
*
Question - Required -
Date of trapping incident
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
1957
1956
1955
1954
1953
1952
1951
1950
1949
1948
1947
1946
1945
1944
1943
1942
1941
1940
1939
1938
1937
1936
1935
1934
1933
1932
1931
1930
1929
1928
1927
1926
1925
1924
1923
1922
1921
1920
1919
1918
1917
1916
1915
1914
1913
1912
1911
1910
1909
1908
1907
1906
1905
1904
1903
1902
1901
1900
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Question - Required -
City or town where incident took place
*
Question - Required -
County where incident took place
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Question - Required -
State or province where incident took place
*
Question - Required -
Area where trap was set
Private property
Public property
*
Question - Required -
Habitat description (urban, suburban, forest, campground, stream, etc.)
*
Question - Required -
Type of trap
Steel-jaw leghold
Conibear
Unknown
Other (please specify below)
Question - Not Required -
Other type of trap
*
Question - Required -
Type of animal trapped
Question - Not Required -
Was the animal a pet?
Please select response
Yes
No
Question - Not Required -
Was the animal a hunting dog?
Please select response
Yes
No
*
Question - Required -
Estimate time (hours) animal spent in trap
*
Question - Required -
Type/result of injury (check all that apply)
Please make at least 1 selection from the choices below.
Question - Not Required -
Other injury
Question - Not Required -
Name of attending veterinarian (if applicable)
Question - Not Required -
To what agency, if any, was the incident reported?
*
Question - Required -
Was the trapper charged with a violation of trapping regulations or other laws?
Please select response
Yes
No
*
Question - Required -
If the trapped animal was a pet, did the trapper pay for treatment of the pet's injuries?
Please select response
Yes
No
Question - Not Required -
If not, did the pet's owner bring civil action against the trapper or the state to recover costs?
Please select response
Yes
No
*
Question - Required -
Reason for your involvement
Please select response
Witness
Animal's owner
Attending veterinarian
Humane agent/animal warden
*
Question - Required -
Reason for your involvement
Please make 1 selections from the choices below.
Question - Not Required -
Please provide any additional details pertaining to this incident that might be helpful to The HSUS.
*
Question - Required -
Would you or anyone else associated with the incident be willing to testify on behalf of or otherwise cooperate with The HSUS in programs to end the cruelty of trapping?
Please select response
Yes
No
Question - Not Required -
If yes, please list names, addresses and telephone numbers below.
I hereby give The Humane Society of the United States (HSUS) permission to use any of the information provided in, or in connection with, this form, including my identity and any pohotos or other materials provided with this form, in any way it sees fit, including use in HSUS publications and in testimony before legislative and judicial bodies. I verify that the information on this form is complete and accurate to the best of my knowledge.
*
Question - Required -
Your full name and today's date