Form Instructions

To report a flooding event, please complete the following form:

Contact Information

Name:*

Phone Number:*

Address:*

Email Address:

Flood Information

On what date did you experience flooding?*

What type of flooding did you experience? [Please check all that apply.]

Combined Sewer Backup [Combined sewage coming through floor drain, toilet, shower, sink within basement.] Rear Yard [Water ponding in rear yard] Intersection Ponding [Please provide the intersection that is flooding below.]

Overland Flow [Water coming into structure through a door or window well.] Seepage [Water pushing through joints or cracks in a foundation.]

Intersection:

Brief description of flooding:

Photograph:

If you would like someone from the Department of Public Works to contact you, please fill out the following information. Please note that in severe flooding events it may take several days for a response. If this is an emergency, please contact the Police Department at (708) 579-2333.

Name:

Phone Number:

Email Address: