Required Information
Zoo name
Zoo city
Zoo state
** please choose **
AB
AE
AK
AL
APO
AR
AZ
BC
CA
CO
CT
DC
DE
FL
FM
FPO
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MB
MD
ME
MH
MI
MN
MO
MP
MS
MT
NB
NC
ND
NE
NH
NJ
NL
NM
NS
NV
NY
OH
OK
ON
OR
PA
PE
PR
QC
RI
SC
SD
SK
TN
TX
UT
VA
VT
WA
WI
WV
WY
YK
Date of incident (mm/dd/yyyy)
Death
Escape
Time frame of incident (if the incident occurred over a period of time)
Type of incident (check as many as apply)
Injury to animal(s)
Injury to zoo personnel
Neglect
Abuse
Improper diet
Importation of wild-caught animals
Incompatible social grouping resulting in injury or death
Insufficient veterinary care
Selling, buying, or transferring animals to or from exhibitors, private collections, circuses, exotic animal auctions, canned hunting facilities, or zoos not accredited by the American Zoo and Aquarium Association
Unsuitable habitat (i.e., enclosures too small, poorly designed, unsafe, not maintained)
Frivolous spending (funding spent on landscaping, sculptures, amusement rides, etc., instead of providing better care or facilities for animals)
Stereotypic/repetitive behavior (behavioral disturbances, including pacing, head-bobbing, rocking, swaying, bar-biting, pulling out hair or feathers, and self-inflicted wounds)
Inadequate environmental enrichment
Dangerous handling practices that endanger keepers, animals, or the public
Insufficient or untrained staff
Species
Animal name(s)
Animal age(s)
Description of the incident/situation (please include as many additional details as possible for each incident)
Was this animal born at the zoo? If not, where did he/she come from?
Person(s) involved
Optional Information
E-mail
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First name
Last name
Address 1
Address 2
City
State/Province
** please choose **
ACT - Australian Capital Territory
Jervis Bay Territory
NSW - New South Wales
NT - Northern Territory
QLD - Queensland
SA - South Australia
TAS - Tasmania
VIC - Victoria
WA - Western Australia
** please choose **
Antwerp
East Flanders
Flemish Brabant
Hainaut
Liege
Limburg
Luxembourg
Namur
Walloon Brabant
West Flanders
** please choose **
AB
BC
MB
NB
NL
NS
NT
NU
ON
PE
QC
SK
YT
** please choose **
Anhui
Beijing
Chongqing
Gansu
Guangdong
Guangxi
Guizhou
Hainan
Hebei
Heilongjiang
Henan
Hong Kong
Hubei
Hunan
Jiangsu
Jiangxi
Jilin
Liaoning
Macau
Nei Mongol
Ningxia
Qinghai
Shaanxi
Shandong
Shanghai
Shanxi
Sichuan
Taiwan
Taiwan
Tianjin
Tibet
Xinjiang Fujian
Yunnan
Zhejiang
** please choose **
Alsace
Aquitaine
Auvergne
Brittany
Burgundy
Centre
Champagne-Ardenne
Corsica
Corsica
Franche-Comt
le-de-France
Languedoc-Roussillon
Limousin
Lorraine
Lower Normandy
Midi-Pyrnes
Nord-Pas-de-Calais
Pays de la Loire
Picardy
Poitou-Charentes
Provence-Alpes-Cte d'Azur
Rhne-Alpes
Upper Normandy
** please choose **
Baden-Wrttemberg
Bavaria
Berlin
Brandenburg
Bremen
Hamburg
Hesse
Lower Saxony
Mecklenburg-Vorpommern
North Rhine-Westphalia
Rhineland-Palatinate
Saarland
Saxony
Saxony-Anhalt
Schleswig-Holstein
Thuringia
** please choose **
Andaman and Nicobar Islands
Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chhattisgarh
Dadra and Nagar Haveli
Daman and Diu
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
National Capital Territory of Delh
Orissa
Pondicherr
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telangana
Tripura
Uttar Pradesh
Uttaranchal
West Bengal
** please choose **
Aceh
Bali
Bangka-Belitung
Banten
Bengkulu
Gorontalo
Jakarta Raya
Jambi
Jawa Barat
Jawa Tengah
Jawa Timur
Kalimantan Barat
Kalimantan Selatan
Kalimantan Timur
Kepulauan Riau
Lampung
Maluku
Maluku Utara
Nusa Tenggara Barat
Nusa Tenggara Timur
Papua
Papua Barat
Riau
Sulawesi Barat
Sulawesi Selatan
Sulawesi Tengah
Sulawesi Tenggara
Sulawesi Utara
Sumatera Barat
Sumatera Selatan
Sumatera Utara
Yogyakarta
** please choose **
Auckland
Johor
Kedah
Kelantan
Kuala Lumpur
Labuan
Melaka
Negeri Sembilan
Pahang
Penang
Perak
Perlis
Putrajaya
Sabah
Sarawak
Selangor
Terengganu
** please choose **
Aguascalientes
Baja California Norte
Baja California Sur
Campeche
Chiapas
Chihuahua
Coahuila
Colima
Distrito Federal
Durango
Guanajuato
Guerrero
Hidalgo
Jalisco
Mxico
Michoacan
Morelos
Nayarit
Nuevo Leon
Oaxaca
Puebla
Queretaro
Quintana Roo
San Luis Potosi
Sinaloa
Sonora
Tabasco
Tamaulipas
Tlaxcala
Veracruz
Yucatan
Zacatecas
** please choose **
Drenthe
Flevoland
Friesland
Gelderland
Groningen
Limburg
North Brabant
North Holland
Overijssel
South Holland
Utrecht
Zeeland
** please choose **
Auckland
Bay of Plenty
Canterbury
Chatham Islands Territory
Gisborne
Hawke's Bay
Manawatu-Wanganui
Marlborough
Nelson
Northland
Otago
Southland
Taranaki
Tasman
Waikato
Wellington
West Coast
** please choose **
Abra
Agusan del Norte
Agusan del Sur
Aklan
Albay
Antique
Apayao
Aurora
Basilan
Bataan
Batanes
Batangas
Benguet
Biliran
Bohol
Bukidnon
Bulacan
Cagayan
Camarines Norte
Camarines Sur
Camiguin
Capiz
Catanduanes
Cavite
Cebu
Compostela Valley
Cotabato
Davao del Norte
Davao del Sur
Davao Occidental
Davao Oriental
Dinagat Islands
Eastern Samar
Guimaras
Ifugao
Ilocos Norte
Ilocos Sur
Iloilo
Isabela
Kalinga
La Union
Laguna
Lanao del Norte
Lanao del Sur
Leyte
Maguindanao
Marinduque
Masabate
Metro Manila
Misamis Occidental
Misamis Oriental
Mountain Province
Negros Occidental
Negros Oriental
Northern Samar
Nueva Ecija
Nueva Vizcaya
Occidental Mindoro
Oriental Mindoro
Palawan
Pampanga
Pangasinan
Quezon
Quirino
Rizal
Romblon
Samar
Sarangani
Siquijor
Sorsogon
South Cotabato
Southern Leyte
Sultan Kudarat
Sulu
Surigao del Norte
Surigao del Sur
Tarlac
Tawi-Tawi
Zambales
Zamboanga del Norte
Zamboanga del Sur
Zamboanga Sibugay
** please choose **
AE
AK
AL
American Samoa
APO
AR
Armed Forces Americas (AA)
Armed Forces Pacific (AP)
AZ
CA
CO
CT
DC
DE
FL
FM
FPO
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
Palau
PR
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Country/Region
** please choose **
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua
Argentina
Armenia
Australia
Austria
Azerbaijan
Azores
Bahamas
Bahrain
Balearic Islands
Bangladesh
Barbados
Barbuda
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Canary Island
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo (Brazzaville)
Congo, Democratic Republic
Cook Islands
Corsica
Costa Rica
Côte d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
England
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Faroe Islands
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Herzegovina
Honduras
Hong Kong SAR
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Ireland Northern
Irish Republic
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kirghizstan
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Lagos
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau SAR
Macedonia
Madagascar
Madeira
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Scotland
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Spitzbergen
Sri Lanka
St. Vincent and Grenadines
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Tobago
Togo
Tonga
Trinidad
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Virgin Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Wales
Western Sahara
Yemen
Zambia
Zimbabwe
Zip/Postal Code
Tel.
Tel. (cell or other)
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