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Asset Management Division

Maintenance Request Form

This form should NOT be used to report any kind of Highway EMERGENCY.

If this is after business hours and life threating, please contact 911. If it isn't life threating and after business hours, please contact your transportation department Road Repair Hotline at: (555) 555-5555

You can use the form below to submit a work request for maintenance. Requests are limited to the Maintenance Item - Description drop down list. However, if you do not find what you want to report in the Maintenance Item - Description drop down list then please click on Other and describe, in detail, your request.

Please note: we are responsible for only state-owned roads which are interstates and state routes.

Our goal is to provide you with the best service possible. To accomplish this goal we must collect as much relevant information as possible concerning your maintenance work request. Several of the fields within the form are mandatory. Mandatory fields are identified with an asterisk "*"

Also, please follow driving laws in your state; no texting and driving.

Contact Info:

First name

Last name

Phone Number

Type of Requestor

Type of Maintenance Request

Maintenance Request Location:

County

Route Type

Interstate or State Route Name

Log Mile

If the Mile Marker or Log Mile is unknown, please describe the location in the comments below.

Direction

Multi – Lane:

Yes No

If multi-lane, which lane is the maintenance needed? (The lane closest to the median is always Lane 1).

Comments:

To file a property damage or personal injury claim use the following link: https://example.gov/Services/Claims-and-Risk-Management/TORT-Liability

Request a follow-up from the transportation department Yes, I would like a follow-up from the transportation department

How would you like to be contacted?

Phone Email