Form Center

2. Incident Report
   The Town of Castle Rock is committed to providing the best service possible with the resources that we have available. In order to report an incident, please provide the following information. All insurance claims will be submitted to the Town of Castle Rock’s insurance carrier for review and determination of liability. By acceptance of this report, the Town of Castle Rock is not assuming liability or responsibility for the incident.
4. First name*
5. Last name*
7. Address*
9. City*
10. State*
11. Zip*
13. Telephone number*
14. Email address
16. Date of incident
    Date of incident
17. Time of incident*
19. Location of incident (full address or closest street intersection).*
21. Description of incident; describe in detail what happened.*
23. Were there any witnesses?*

    1. Yes
    2. No
24. If yes, please provide their names and contact information.
26. Did the police investigate?*

    1. Yes
    2. No
27. What jurisdiction? (i.e., Castle Rock Police, Douglas County Sheriff, State Patrol)
28. Please include the Police Report number
29. Attach Police Report
31. Attach any pertinent information (i.e., repair estimates, invoices, photos). Preferred format is .pdf or .jpg.
33. Attachment 1
34. Attachment 2
35. Attachment 3
36. Attachment 4
38. Attachment 5
39. Attachment 6
40. Attachment 7
41. Attachment 8
43. Additional comments you may have
Leave This Blank:


45. 1. Receive an email copy of this form.
46. Email address

    This field is not part of the form submission.

47. Submit

* indicates a required field