Halloform
Government & Public Sector

Pothole & Road Hazard Report form template

A fast mobile report for residents to flag potholes, broken streetlights, and other road hazards. Pinpoints the location, gathers a photo, and routes the issue to the public works crew for prioritized repair.

311 ServiceMobile-readyPhotos
Open preview in new tab

Whatโ€™s in the box

Snap & send

Attach a photo so crews can assess severity before arriving.

Exact location

Capture the street address or nearest intersection.

Status updates

Optional contact info for repair notifications.

Perfect for

  • Pothole reports
  • Broken streetlights
  • Damaged road signs
  • Fallen tree limbs
  • Flooded roadways

Other templates you might like

Browse all โ†’

Start with Pothole & Road Hazard Report, ship today

Free forever for up to 1,000 submissions a month. No credit card.

Use this template