JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Flood Report Form
This questionnaire, for City of Bexley residents, is being used both as an initial step to determine types and causes of basement flooding and for long-range capital improvement project consideration.
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Name
*
Your answer
Email Address
*
Your answer
Phone Number
*
Your answer
Address
*
Your answer
How long have you lived at this address?
*
Less than 1 year
1-5 years
5-10 years
10-20 years
20+ years
Required
Have you previously participated in the City's residential sanitary sewer inspection and remediation program?
*
Yes - inspection only - no issues identified
Yes - inspection only - repairs not yet completed
Yes - inspection and repairs completed
No
Required
Non-resident property owner's name, e-mail and cell phone (if not the same as above)
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of The City of Bexley.
Report Abuse
Forms
