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Clackamas County 911

Premise Hazard Form

Premise Hazard Form

This form is intended to create address-specific flags in our computer-aided dispatch (CAD) system. Please provide as much detail as possible when reporting the type of hazard or information to be added to our systems.

NOTE: IF URGENT, PLEASE CALL IN TO HAVE TEMPORARY HAZARD ENTERED, IN ADDITION TO FILLING OUT BELOW FORM.

Your Information

Specify the time period this will be active 365 days max.
Is this a:

Premise/Address to Flag

Is this a business or residence? optional

Person(s) Involved (enter all information that is known)

Second person
Third person

Vehicle Information if related

Second vehicle
Third vehicle

Weapons/Hazardous Materials

Hazard Description/Reason

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