Report streetlight outages

Section
First name*
Last name*
Email (john@smith.com)*
Confirm Email*
City*
County
Phone (4151234567)*
Extension
I am a city/county/other government agency employee*
If yes, agency/title (Optional)
Total count of lights being reported (from 1 to 10)*
Choose best description of situation*
Light Parent
Please verify that you are not a robot. Select the check box and click submit to verify.*
Submit

Section
Light Parent

Form Name

To Address

Subject

Success page

Error page

Email template

Personal Information

First name*

Last name*

Email (john@smith.com)*

Confirm Email*

City*

County

Phone (4151234567)*

Extension

I am a city/county/other government agency employee*

Yes

If yes, agency/title (Optional)

Total count of lights being reported (from 1 to 10)*

Choose best description of situation*

Lights are individually out / broken and are widely scattered across area

Lights are all grouped together in one area, but are individually out / broken

Lights are all together in one area and are out as a group (possible power outage or wiring problem)

Streetlight Information #1

Pole/Light number(s)*

(located seven feet from bottom of pole)

Location of streetlight(s)*

(e.g. 2nd pole from NE corner of 7th st & Main st)

The light is (check all that apply)*

On a traffic signal pole

On a light pole

On a metal pole

On a wood pole

On top of a post

Not on a pole

HP Sodium Vapor

Mercury Vapor

Incandescent

Not sure

Choose best description of issue(s) with the streetlight issue(s)*

Burnout

Flickering

Cycling

Dim

Day Burner

Vandalism

Other Issue

Is the light difficult to access? If so, please describe any accessibility issues*

Yes

Please verify that you are not a robot. Select the check box and click submit to verify.*