Utility Duct Blockage Report Form
Please complete this form to report a blockage in a utility duct. Your detailed input helps us address the issue promptly.
Full Name
*
First Name
Last Name
Email Address
*
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Location of Blockage (Address or Nearest Landmark)
*
Date and Time Blockage Was Observed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Type of Utility Duct
*
Please Select
Electrical
Telecommunications
Water
Sewer
Gas
Other
Describe the Blockage
*
Severity of Blockage
*
Minor (Partial obstruction)
Moderate (Significant obstruction)
Severe (Complete blockage)
Upload Photo of Blockage (if available)
Upload a File
Drag and drop files here
Choose a file
Cancel
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Has this blockage been reported before?
Yes
No
Not Sure
Additional Comments or Details
Submit Report
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