Water Main Break & Leak Emergency Report Form
Water Main Break & Leak Emergency Report Form
Urgent utility report for water main breaks, street flooding, or sinkholes triggering emergency response from public works.
If water is actively gushing, also call the emergency dispatch line. This form dispatches crews but may not be fastest.
Reporter name *
Your answer
Phone (for callback)
Break location address or intersection *
Your answer
Type of water issue
Water gushing from street
Water bubbling up
Sinkhole forming
Low pressure entire block
No water service
Discolored water
Hydrant leaking
Severity
Emergency (flooding, sinkhole)
Urgent (visible loss)
Moderate (slow leak)
Minor (seepage)
Is water entering homes or buildings?
+ 5 more questions
About this template
Urgent utility report for water main breaks, street flooding, or sinkholes triggering emergency response from public works.
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