Pothole reporting form

Thank you for reporting a pothole.

To help us please give us as much information as you can in the boxes below. The details marked * are mandatory. If you think the pothole is very dangerous and in need of urgent attention, please telephone 0117 922 2100 Monday to Friday 08:30 to 20:00 (except Bank Holidays) or to 0117 922 2050 at any other time.

Your details
Title: (Mr/Mrs/Ms/Dr/Rev)
Forename:*	(required)
Surname:*	(required)
Telephone No.:*	(required)
Address:*	(required)
Postcode:*	(required)
Email Address:*	(required)
Location of Pothole
Please enter the name of the road:*	(required)
Please enter the area of the city:*	(required)
Please enter the house number of the nearest property:
Further information about the location:* (Exact location information, ie: closest to which house number / landmark / road junction.)	(required)
Is the hole directly outside of the property?	Yes No
Is the hole on a footway or the road?	Footway Road
Is the hole part of works by contractor? If yes, please give their name or who they are working for.
Description / size of hole
Size:	Small (less than 300mm / 1 foot) Large (over 300mm / 1 foot)
Depth:	Shallow (less than 40mm / 2in) Deep (over 40mm / 2in)
Any other information:

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Pothole reporting form

Your details

Location of Pothole

Description / size of hole

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