City Maintenance Observation Log Form
Log and track city maintenance issues observed in your area. Please provide as much detail as possible to help us address the issue efficiently.
Date and Time Observed
*
-
Month
-
Day
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Issue (Address or Nearby Landmark)
*
Type of Maintenance Issue
*
Pothole
Broken Streetlight
Damaged Sidewalk
Graffiti
Overflowing Trash
Blocked Drain
Other
Severity of Issue
*
Low (Minor inconvenience)
Medium (Needs attention soon)
High (Immediate action required)
Detailed Description of the Issue
*
Upload Photos or Attachments (if applicable)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Reporter Name (optional)
First Name
Last Name
Reporter Email (optional)
example@example.com
Reporter Phone Number (optional)
Please enter a valid phone number.
Format: (000) 000-0000.
Follow-up Actions or Resolution Notes
Submit Observation
Should be Empty: