Forms

Display Form

Garbage & Recycling

Waste, recycling, compost requirements and scheduling.

Agendas & Minutes

Agendas and minutes for upcoming and past City Council and Committee Meetings. Live stream Council meetings as they happen from CivicWeb.

River Webcams

Two Live River Webcam views. One looking West on Blockhouse Islands and one looking South from the back of City Hall.

Careers at the City

Apply for current available positions with the municipality, and learn about the perks of working at the City.

Municipal News

Municipal news and updates relevant to our residents.

Have Your Say

Public engagement surveys and requests for input.

Support & Assistance

Customer service assistance including bill payments, reporting an issue, or filling out an application.

Display Form

Insurance Claims form

"*" indicates required fields

Any information which you provide on this on-line form will be kept confidential.

Personal information on this form is collected under the authority of the Municipal Act, 2001, S.O. 2001, C.25 and will be used to process your claim with the City of Brockville. Questions about the collection of this personal information should be directed to the Risk Management Coordinator, 1 King Street West, P.O. Box 5000, Brockville, ON K6V 7A5 (T) 613-342-8772 ext. 4485.

NOTE: Be aware that there is a 10 day notice for providing the City with Notice of certain types of claims and a two year limitation period for bringing an action in respect to all claims.

Personal Information of Claimant

Name*

First Middle Last

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Work Phone

Email*

Contact Information (if different from above)

Name

First Middle Last

Address

Street Address Address Line 2 City Province Postal Code

Phone

Work Phone

Incident Information

Incident Date*

Time of Incident*

Location description (including address if known)*

Closest intersection or reference point*

Facility

Location of Facility

Other

Description of incident, including property damage and injuries.*

Is this your first report of this incident to the City?*

Yes

Identify the employee or section report was made to

Employee Name

Department

Witness Information (1)

Name*

First Middle Last

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Work Phone

Witness Information (2)

Name*

First Middle Last

Address*

Street Address Address Line 2 City Province Postal Code

Phone*

Work Phone

What would you like the City to do?*

Claimant Signature*

Today's Date*

CAPTCHA

I Want to...

Forms

Garbage & Recycling

Agendas & Minutes

River Webcams

Careers at the City

Municipal News

Have Your Say

Support & Assistance

Display Form

Insurance Claims form

Personal Information of Claimant

Contact Information (if different from above)

Incident Information

Witness Information (1)

Witness Information (2)