Form Center

Welcome to the City of Rockville Form Center. If your form requires a response, we will contact you as soon as possible.
By signing in or creating an account, some fields will auto-populate with your information and your submitted forms will be saved and accessible to you.

Non-Injury Incident Report Form

  1. Form Instructions

    Use this form to file reports to the City's Safety & Risk Management Division for the following types of incidents: property damage to City property, graffiti, City tree falling down and damaging property, reports of uneven sidewalks, potholes, other public safety hazards, etc.

  2. Type of Claim*

  3. Please provide a thorough description of the incident. Written witness statements, police reports, photos and other supporting documents can be attached below

  4. Responding Police Department*

  5. Has the Unsafe Condition been Addressed?

  6. Please answer the questions below if this was a vehicle accident involving a City vehicle.

  7. Was Driver or Passenger Injured?

  8. Was City Vehicle Towed?

  9. You are required to submit to post-accident drug and alcohol testing if you were driving a City vehicle and involved in an accident, regardless of fault, and damage occurred to either the City vehicle, other vehicle involved or property damage of any kind. Please immediately contact the Human Resources Department at 240-314-8470 to schedule an appointment with Concentra to perform this testing. You are not authorized to operate City vehicles or equipment until the Safety & Risk Manager provides written authorization regarding your negative test results. This policy excludes the Police Department. The Police Department follow General Order policy 4-6.

  10. Leave This Blank:

  11. This field is not part of the form submission.