BARKING DOGS COMPLAINT FORM - Golden Plains Shire

ENVIRONMENT SERVICESANIMAL MANAGEMENTBARKING DOGSCOMPLAINT FORM2 Pope StreetPO BOX 111BANNOCKBURN VIC 3331Telephone: 03 5220 7111STD Toll Free Within Shire :1300 36 30 36Facsimile: 03 5220 7100Complainant’s NameAddressContact Phone(Home) (Business) (Mobile)Address of Offending Dog/s:Description of Dog/s(Colour and Breed of Dog/s)Have you verified where the barking is coming from? YES NOHave you seen the dog/s barking? YES NOHave you spoken to the owners about this problem? YES NOIf yes, what was his/her response?Are you prepared to have the matter mediated? YES NOHave any of your neighbours mentioned this problem to you? YES NOIf YES, are they prepared to support your claim? YES NOI, the undersigned, request that a Community Protection Officer of Golden Plains Shire Council investigatethe alleged nuisance, and I undertake:• To give full information to the Council as to this matter, and• Assist the Council in any further investigations relating to this complaint.SignedDateQuestions on the reverse of this form must be answered.Privacy note: All personal information included in this form will only be used or disclosed with respect to any investigations orlitigation relating to this report. It may also be used to contact you, to request attendance in Court and give evidence as a witness inrelation to this investigation, if required to do so by Golden Plains Shire Council.G:\Development\Environment Services\Community Protection\Forms\40_AM_EV- barking dogs complaint form.doc Rev 4/06/08Form 40

ENVIRONMENT SERVICESANIMAL MANAGEMENTBARKING DOGSCOMPLAINT FORM2 Pope StreetPO BOX 111BANNOCKBURN VIC 3331Telephone: 03 5220 7111STD Toll Free Within Shire :1300 36 30 36Facsimile: 03 5220 7100How to Complete a Barking Dog DiaryYour accuracy in recording the nuisance barking is of extreme importance as it may be presented asevidence in Court. Please create a detailed diary over a two-week period as demonstrated in theexample below and submit the diary to Council with the Barking Dog Complaint FormDateTimeBarkingStartedTimeBarkingStoppedEXAMPLE ONLYBarking for howlong?Reason for barking(Person walking past, weather, anotheranimal, aircraft, etc)11/02/05 3:00 pm 3:02 pm 4 barks Nobody in street11/02/05 3:10 pm 3:13 pm 8 barks Man walking dog11/02/05 3:18 pm 3:18 pm 2 barks Nobody in street11/02/05 3:28 pm 3:30 pm 16 + barks Children in street11/02/05 3:33 pm 3:33 pm 3 barks Nobody in street11/02/05 3:45 pm 3:47 pm 6 barks Plane passing over11/02/05 3:52 pm 3:52 pm 2 barks Nobody in street11/02/05 3:58 pm 4:03 pm 16 + barks Cat on fence11/02/05 5:22 pm 5:24 pm 10+ barks Neighbour returned homeThis may seem excessive, but this information is necessary in order for Council officers to help the dogowner address the problem. It also forms the basis of the accurate and concise evidence you would berequired to give before a Magistrate should the problem ever be taken to Court. Forward completed“Barking Dog Complaint Form” and “Barking Dog Diary” to:Local LawsGolden Plains Shire2 Pope StPO Box 111Bannockburn 3331Please describe the problem? (ie. How long, when, how often etc)ORLocal LawsGolden Plains Shire68 Sussex StLinton 3360What effect (if any) does the noise have on you?Please add any further comments?The Golden Plains Shire considers that the responsible handling of personal information is a key aspect ofdemocratic governance, and is strongly committed to protecting an individual’s right to privacy. Council willcomply with the Information Privacy Principles as set out in the Information Privacy Act, 2000. Council hasin place a standard operating procedure that sets out the requirements for the management and handlingof personal information.If you have any queries regarding this Privacy Statement, please contact the Privacy Officer on 03 52207111.

BARKING DOGS DIARYDateTimeBarking StartedTimeBarking StoppedBarking for How Long?Reason for barking(Person walking past, weather, another animal, aircraft etc)G:\Development\Environment Services\Community Protection\Forms\40_AM_EV- barking dogs complaint form.docG:\Development\Environment Services\Community Protection\Forms\40_AM_EV- barking dogs complaint form.doc 12/05/11Form 40

BARKING DOGS DIARYDateTimeBarking StartedTimeBarking StoppedBarking for How Long?Reason for barking(Person walking past, weather, another animal, aircraft etc)Complainant’s Name: ________________________________________________Signature: ____________________________ Date: ____ / ____ / __________G:\Development\Environment Services\Community Protection\Forms\40_AM_EV- barking dogs complaint form.docG:\Development\Environment Services\Community Protection\Forms\40_AM_EV- barking dogs complaint form.doc 12/05/11Form 40