2. 
4. Your Contact Information
6. To effectively get this hazard fixed, we need your contact information to follow up with both you and the agency in charge of fixing the problem
8. First Name
9. Last Name
11. Address1
13. Address2
15. City
16. State
17. Zip
19. Your email
21. Telephone
22. Date
    Date
24. Where is the hazard located
26. Municipality (City, Village or Town):
    -- Select One --Belgium TownBelgium VillagePort Washington TownPort Washington CityGrafton TownGrafton VillageCedarburg CityMequon CityThiensville Village
28. Link to Mile Mark Map
    Link to Mile Marker Map
29. Approximate Location
31. Check one or more hazards
33. Pothole or Pavement Cracks

    1. Pothole or Pavement Cracks
34. Missing trail signage

    1. (e.g. road names crossing, stop, yield, etc.)
36. Rough Surface

    1. Rough Surface
37. Overgrowth Interfering with Line of Sight

    1. Overgrowth Interfering with Line of Sight
39. Debris on Shoulder

    1. Debris on Shoulder
40. Trail (paths, lanes, routes)

    1. Not Clearly Marked
42. Debris on Trail

    1. (e.g. glass)
43. Railroad Hazard

    1. Railroad Hazard
45. Hazardous Drainage

    1. Hazardous Drainage
46. Damaged Signage

    1. Damaged Signage
48. Protruding vegetation/fallen tree

    1. /vegetation through pavement
49. Damage to Trailside Facilities

    1. Damage to Trailside Facilities
51. Unauthorized vegetation removal

    1. or damage in right-of-way
53. Other (please describe below):
55. Do you have a digital picture of the hazard
56. Attach photo
58. Would you like to receive the 'Ozaukee Interurban Trail Advisory Councils'

    1. monthly email newsletter
60. Would you like to donate to the 'Ozaukee Interurban Trail Advisory Council?
61. Donated Now
    Click here to Donate
65. The Ozaukee Interurban Trail Advisory Council is not responsible for repairing any hazards.
67. This form is forwarded to the appropriate public works department for the agency with jurisdiction over the right of way the hazard exists.
69. Thank you for participating in the Hazard Reporting Program!
71. Back to Interurban Website
    Back to Interurban Website
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73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit

* indicates a required field