Road Damage Assessment Form
Use this form to assess and report road damage accurately and efficiently. Please fill in all relevant details to help prioritize repairs.
Assessment Location
*
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Type(s) of Road Damage Observed
*
Potholes
Cracks
Surface Erosion
Edge Break
Depressions
Other
Severity of Damage
*
1
2
3
4
5
Approximate Size of Damaged Area (meters)
Is the road currently safe for traffic?
*
Yes
No
Uncertain
Priority Level for Repair
*
Low
Medium
High
Upload Photo(s) of Damage
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Additional Comments or Observations
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