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Incident Form


NOTE: If you select 'No', the City of Sault Ste. Marie is unable to accept your online form as notice to the City about your claim.
Claimant Information











Contact Information










Incident Information


HH:MM pm or HH:MM am


Please provide specific information regarding the events surrounding your claim.

What costs, if any, have you incurred as a result of this incident? Please provide supporting documentation.




Police Report
Note: Pursuant to s. 199 (1) of the Highway Traffic Act, R.S.O 1990, c. H. 8, individuals who are involved, either directly or indirectly, in a vehicle-related accident that results in personal injuries or property damage in excess of $2,000.00 report the accident to the nearest police officer forthwith.

From Motor Vehicle Collision Report

Ex: SSM Police Service, OPP, etc


Vehicle Incident Information





Property Damage Information

Please provide specific information regarding the damage sustained to your personal property.
Insurance Provider Information



Personal Injury Information
Please provide specific information regarding the medical aid you received and/or are receiving as a result of the incident





Please provide specific information regarding the injuries you sustained.


There was Construction in the Area

Attachments
Please include copies of all documentation you currently have related to this incident so that your claim can be considered. Additional documentation subsequent to submitting this form should be forwarded to the City's Legal Department for further consideration.

Form Encrypted - While your form data will be encrypted, file uploads are stored unencrypted and will be hosted publicly on a 3rd party CDN. Note: There is a 35mb limit per file upload.

Form Encrypted - While your form data will be encrypted, file uploads are stored unencrypted and will be hosted publicly on a 3rd party CDN. Note: There is a 35mb limit per file upload.

Form Encrypted - While your form data will be encrypted, file uploads are stored unencrypted and will be hosted publicly on a 3rd party CDN. Note: There is a 35mb limit per file upload.

Form Encrypted - While your form data will be encrypted, file uploads are stored unencrypted and will be hosted publicly on a 3rd party CDN. Note: There is a 35mb limit per file upload.

Form Encrypted - While your form data will be encrypted, file uploads are stored unencrypted and will be hosted publicly on a 3rd party CDN. Note: There is a 35mb limit per file upload.

Form Encrypted - While your form data will be encrypted, file uploads are stored unencrypted and will be hosted publicly on a 3rd party CDN. Note: There is a 35mb limit per file upload.
Any person who, with intent to defraud or knowing that he/she is facilitating a fraud, or submits an application or files a claim containing a false or deceptive statement, is guilty of fraud.
If you have any knowledge that the alleged damages might have occurred as a result of work being performed by a contractor on behalf of The Corporation of Sault Ste. Marie (the "City") or a public utility, please report this information to the City Clerk's Department immediately (705-759-5388).

The personal information contained on this form shall be used solely for the purpose of processing the damage and/or personal injury claim and will be supplied to the City’s insurance adjuster and/or to those from whom the City is claiming contribution or indemnity. Questions about this collection of information can be made to the City's Legal Department (705-759-5400).