Animal Welfare Complaint Worksheet

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UNITED STATES DEPARTMENT OF AGRICULTURE
ANIMAL AND PLANT HEALTH INSPECTION SERVICE
ANIMAL CARE

ANIMAL WELFARE COMPLAINT
COMPLAINT NO.:

DATE ENTERED:

PROCESSED BY:

REFERRED TO:

REPLY DUE:

FACILITY OR PERSON COMPLAINT FILED AGAINST
NAME:

CUSTOMER NO.:

ADDRESS:

LICENSE NO.:

EMAIL ADDRESS:

CITY:

STATE:

TELEPHONE NO.:

COMPLAINANT INFORMATION
NAME:

ORGANIZATION:

ADDRESS:

EMAIL ADDRESS:

CITY:

STATE:

TELEPHONE NO.

HOW WAS COMPLAINT RECEIVED?

DETAILS OF COMPLAINT:

RESULTS:

APPLICATION KIT PROVIDED:
YES

NO

INSPECTOR:

DATE:

REVIEWED BY:

DATE:

APHIS FORM 7087
FEB 2023

OMB APPROVED
0579-0036