Streetlight Outage & Maintenance Report Form
Streetlight Outage & Maintenance Report Form
Resident-submitted report of broken, flickering, or dim streetlights for city public works to dispatch repair crews.
Reporter name (optional) *
Your answer
Email (for status updates)
Phone (optional)
Nearest address or intersection *
Your answer
Streetlight pole number (if visible) *
Your answer
Problem type
Light out completely
Flickering
Dim/weak
Stays on during day
Knocked down/damaged
Exposed wiring
Severity/safety concern
How long has it been out?
< 1 week
1-4 weeks
1-3 months
3+ months
Don't know
+ 4 more questions
About this template
Resident-submitted report of broken, flickering, or dim streetlights for city public works to dispatch repair crews.
How does it work?
Click Use template. We'll drop a copy into your Formswrite workspace - no setup needed.
Tweak the questions, branding, and logic to fit your workflow. Add your logo, colors, and cover image.
Publish and share the link, embed it on your site, or drop it into a chatbot widget. Responses stream straight to your dashboard.