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ANIMAL/REPTILE/INSECT (ARI) - RELATED DEATH NAME OF DECEDENT: This form is to be completed in addition to the ROD form in these guidelines ANIMAL/REPTILE/INSECT (ARI) DESCRIBE ANIMAL, REPTILE, OR INSECT: IS THIS A PET BELONGING TO THE DECEDENT, FAMILY, OR SOMEONE ELSE? IS THIS ARI CONSIDERED POISONOUS? DOES THIS A RI HAVE PAST HISTORY OF ATTACKING/BITING/STINGING, ETC? IS THIS ARI NATIVE TO THE ENVIRONMENT? WAS THE ARI KEPT IN AN ENCLOSURE? IF SO, HOW DID IT GET OUT? IS THE ARI AVAILABLE FOR EXAMINATION? HAS THE ARI BEEN DESTROYED? IF APPLICABLE, WAS ANIMAL INNOCULATED FOR RABIES? WAS THIS A WITNESSED ATTACK? NO IF YES, DESCRIBE WHAT WAS WITNESSED: WHAT MEDICAL ATTENTION DID THE DECEDENT RECEIVE AFTER THE ATTACK (DESCRIBE IN
DETAIL): NAME OF INVESTIGATOR DMI#