Moundsville Street Department
Roadway Defect Report Form
Name
enter your full name
Email
your email address
Location *
give a brief description of the roadway defect and the location of that defect. Be as specific as possible about the location.
Type of defect
please indicate the category which most fit the defect that you are reporting
Pothole
broken curb
broken sidewalk
missing guardrail
missing signage
traffic light malfunction
street light out
obstructed view
other
Do you want us to contact you about this problem?
yes
no
what is the best way to contact you?
telephone
email
other
Contact information
describe how you want the City to contact you: if via telephone then indicate the number. If email, provide email address in the area indicated previously
Type the following:
For security purposes, please type the letters in the image.