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Tuesday March 16th

Sewer and Water 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. Complete the online form below, or download the form here: Claim for damages - Sewer/Water

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

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

Contact Information
Damage Information

How did damage occur? Give full explanation.

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Describe fully where the damage occurred.

Depth of water and type of water (i.e., clear, muddy, etc.).

Indicate weather conditions. When rain commenced and ended, if applicable.

Was there sewer odor in your residence?

Have you had prior backups or sewer water problems?

If yes, state when and describe.

If yes, describe extent of sepage.

City Contacts

Did you call the City with reference to this claim?

If yes, give the names of the City employees, if known.

Name(s) of City employee(s) alleged to have caused the damage or loss, if known.

Substance of conversation with City crews, if any.

Did City crews investigate this claim?

What Damage or injuries do you claim resulted? Complete Damage List below.

Insurance payments, if any, and name of insurance company.

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