Disaster Non-Emergency Info Reporting
Use this form to report non-emergency / non-life threatening information regarding the current disaster situation in Charlestown, Indiana; to City of Charlestown Officials for review, evaluation and attention. All information reported will be triaged for priority, safety, and availability. EMERGENCY SITUATIONS SHOULD BE IMMEDIATELY REPORTED BY DIALING 911; NOT USING THIS FORM.
Reporting Person Name (YOUR NAME)
*
First Name
Last Name
Reporting Person Contact Phone Number
Please enter a valid phone number.
LOCATION (Address or location of information being reported)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Reporting Person Email (YOUR EMAIL ADDRESS)
example@example.com
Describe Information you are reporting:
*
Comments:
Submit
Should be Empty: