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Friday March 19th

General Damage Incident Report OnLine

Please read the entire Damage Incident Report before completing.

This form should be filed with the City Recorder at the City of Oregon City as soon as possible after the date of the incident. Cooperation in completing this form will expedite claim processing.  You may complete the online form below or download a form here:  Claim for Damages - General

If you have any questions, please contact the City Recorder at 503-496-1505 or nide@orcity.org.

Please attach additional information that may be helpful in resolving this claim, such as repair estimates
and photographs. Thank you.

Contact Information
Damage or Injury Information

What City Department Director investigated this claim?

What damage and/or injury do you claim resulted from this incident?

What was the date the damage occurred?

:

What was the time of day?

If this involved an injury, where was the injured person(s) taken for medical assistance?

Please indicate conditions at the time of the incident (for example: dark or light, wet or dry).

If yes, please give that employee’s name.

If yes, please give the name of the insurance company.

Have any insurance payments been made as a result of this incident?

$

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