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Education- Flood Report Form

En Enspanol

Please fill out the following form to report flooding problems.
Name:
Email:
Address:
City:
Zip:
Phone:

How long have you lived at your current address?
years

Do you live in the regulatory floodplain?
yes
no
not sure
Do you have flood insurance?
yes no
How often does your street experience flooding?
rarely
1-2 times per year
3-5 times per year
greater than 5 times per year
Has your street been impassable due to flooding?
yes no
Has your house ever flooded?
If so, how many times?
yes time(s)
no
Have you had to contact city maintenance to correct a drainage problem?
yes no
Was the problem corrected?
yes no
Did you experience a flooding problem after the correction?
yes no

Because your assistance is important, we thank you for your response.