STANDING WATER MONITORING REPORT FORM

Help eliminate the West Nile Virus. Mosquitoes need stagnant or standing water to lay their eggs. To reduce the mosquito population around your home, and properly reduce or eliminate all stagnant water, we are asking residents for help.

Multnomah County Vector and Nuisance Control is taking standing water complaints for tracking purposes in order to identify potential problem areas. Vector Control will not be able to visit and treat all reported nuisances, therefore, we are depending on our residents and business owners to eliminate standing water on their property.

Directions:

This form is only for locations within Multnomah County, Oregon. Enter all information requested below by typing in the available spaces. Use the Tab button to move from box to box or use your mouse to point and click. Use your Space Bar or mouse clicks to make checks within the boxes. After all the information is entered, use the Submit button at the bottom of the page to submit the Standing Water Monitoring Report form.

Standing Water Reported by (we may need to contact you for additional information):

Your name:  
 Your address:  
Day phone:  

Evening phone

Email address:  
 Zip Code:
Today's date:
 Date water was first noticed::
Standing Water Information:

 Unchlorinated swimming pool
 Swimming pool cover
 Discarded tires
 Catch-Basin/Sewer
 Depression in street (example: pot holes, poorly paved street, etc.)
 Ditch in ground
 Small containers (example: bucket, etc.)
 Large Containers (example: Children's Wading Pool, garbage can, refrigerator, etc.)
 Roof Top
 Marsh/Swamp
 Pond
 Roof gutters
 Other  (Describe):

Please classify the standing water as:

 Small (example: bucket, children's wading pool, etc.)
 Medium (example: swimming pool)
 Large (example: large outside area is flooded)

Location of Standing Water:

 Private House
 Apartment Building
 Business/Commercial Property
 Vacant Lot (Abandoned house, non-active construction site, etc.)
 Public Property (Please specify site name):
 Other  (Describe):  

Comments:

 
   

Thank you!

Confidentiality Policy

Information that you give us is confidential, so we will not reveal the source of a complaint. It is important that you give us your name, phone number and address so that Multnomah County Vector and Nuisance Control can contact you for the following reasons:

Vector Home Page | Environmental Health Section | Health Department | Multnomah County

 

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Multnomah County Health Department Web Builder.
The address for this site is: http://www.mchealthinspect.org/vector/standwater.html
Created: February 11, 2003
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