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CORE COMPETENCIES COURSE Final Exam
Before watching the final exam scenario, read through each of the six sections in this final exam so you have an understanding of what information you will need to collect while watching the
scenario. Remember that you will be completing this exam based on the information you were taught in this course, which may
differ from how your department currently handles calls.
Name: ______________________________________________________
Municipality: ______________________________________________
Date: _______________________________________________________
SECTION ONE: REPORT You have just watched the final exam scenario. Using the information you collected, write a complete report of the incident from the time ACO Gualtieri and ACO Ray arrived on scene. Remember that reports should be written using simple language, clearly indicating who is writing the report and include all identifying information for all parties and animals involved.
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SECTION TWO: INTAKE You have taken possession of the biting dog. Fill out the below intake form appropriately. Assume that the dog’s owner, Justin Time of 55 Lost Lane, Billerica, came to claim the biting dog, Pookie, on June 10, 2017( Pookie was at your shelter for 11 days) , and that the Town of Billerica charges $10 per day for care and custody with no pick-up fee. Pookie is vaccinated (proof of vaccination: Dr. Bernard Saint, given 1/1/16, expires 1/1/19) but unlicensed. Assume appropriate steps to license the dog were taken that day and you were able to release Pookie into Justin’s custody.
T H E C O M M O N W E A L T H O F M A S S A C H U S E T T S
ANIMAL CONTROL OFFICER ANIMAL INTAKE REPORT
City or Town of: _________________________________________ Date: _________________Animal Name: ____________________ Animal Type: Dog Cat Other: _____________________
Breed type (Specify) ________________________________________________Approx Age: __________Sex: ___________ Description _________________________________________________ Date and Time caught: _______________________ Where Caught: _____________________________________ Tattoo/Microchip: ________________Tag#:________________ Scanner used: _____________I confined this animal at: _____________________________for a period of ___________ days. Owner contacted on: __________________ Contact Method:__________________________________________________
Redeemed by owner on: __________________ Owner Name:____________________________________________ Date Owner Phone Number: ____________________ Owner Address:_________________________________________ Owner exhibited LICENSE NUMBER: ____________ in the city or town of: _______________________________ Owner paid $_____________ for care and custody @ $__________ per day for ___________ days.
Name: ________________________________ Address: ____________________________ Phone: ____________
Purchaser secured a LICENSE NUMBER _______ in the city or town of : _________________________________ On ______________ and he/she paid an adoption fee of $ __________ that was transmitted to the Town Treasurer.
Rabies vaccination given by: ______________________________________________________________________ Name of Veterinarian
On ___________________________________Rabies vaccination expires on : ______________________________ Date Date
Animal was destroyed on __________________ using__________________________________________________ Date Method of Euthanasia By ___________________________________________________________________________________________ Name and address of veterinarian
On account of this animal there is due me for care and custody _______ days @ $______ per day,$______________ Signed under the pains and penalties of perjury ___________________________________, Animal Control Officer White Copy - Animal Control / Blue Copy— Dog Owner / Pink Copy - City/town Treasurer / Yellow Copy - City/Town Clerk
1. To City or Town Treasurer, I report that I have caught, confined and disposed of an animal as set forth below:
2. Returned to owner:
3. Animal was adopted/transferred to:
4. Rabies vaccination information: (Attach copy of rabies certificate to this form)
4. Euthanasia:
5. Payment:
Animal Control Officers shall report on this form prior to receiving compensation
SECTION THREE: FINDING THE OWNER Describe what steps you are required by law to take to find Pookie’s owner. For extra credit: What additional steps might you take to try to locate her owner? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SECTION FOUR: WHAT IF NO OWNER WAS FOUND DURING HOLD TIME? If no owner was located, what are the options that you have under the MGLs? What steps would you take for each option to ensure that the dog gets a humane outcome?*Extra credit points available for details. ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
SECTION FIVE: RABIES EXPOSURE PROTOCOL Pookie bit Crosby during the incident on May 30, 2017. A rabies quarantine is required, who issues the rabies quarantine? Pookie needs to go to your shelter, what additional precautions need to be taken due to the bite and quarantine? ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ SECTION SIX: UNLICENSED DOG When Justin Time reclaimed Pookie, you learned that Pookie was unlicensed in Billerica. What steps does the owner need to take to reclaim the dog? Pookie was loose and may have violated numerous bylaws and MGLs, list at least two. *extra points given for more ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
SECTION SEVEN: RECORD-KEEPING You now have a written report on the incident and a completed intake form for Pookie. What would you do with these records? Who should receive copies of these records, and how often should you be sending these copies? ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
All Final Exams should be scanned and submitted to [email protected] within 1 week of attending the
Core Competencies Course.
FINAL EXAM SCENARIO Key Facts & Notes Sheet ( for your use only)
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