Hazard Report Form

Name: 

Address:

City:   State:   Zip:

E-mail:

Telephone:

Date:

Municipality (City, Village or Town): 
	Municipality
	Belgium Town
	Belgium Village
	Port Washington Town
	Port Washington City
	Grafton Town
	Grafton Village
	Cedarburg City
	Mequon City
	Thiensville Village


 
Location (and/or mile marker post):



Check one or more:
 Pothole or Pavement Cracks
 Rough Surface
 Debris on Shoulder
 Debris on Trail (e.g. glass)
 Hazardous Drainage
 Protruding vegetation/fallen tree/vegetation through pavement 
 Missing trail signage (e.g. road names crossing, stop, yield, etc.) 
 Overgrowth Interfering with Line of Sight

 Trail (paths, lanes, routes) Not Clearly Marked 
 Railroad Hazard 
 Damaged Signage 
 Damage to Trailside Facilities 
 Unauthorized vegetation removal or damage in right-of-way
 Other (please describe below): 
    
Do you have a digital picture of the hazard 
Photo?
Yes
No
 email photo to Andrew Struck
Would you like to receive the 'Ozaukee Interurban Trail Advisory Councils' monthly email  newsletter  Yes
Would you like to donate to the 'Ozaukee Interurban Trail Advisory Council?  Yes  
 
The Ozaukee Interurban Trail Advisory Council is not responsible for repairing any hazards.  
This form is forwarded to the appropriate public works department for the agency with jurisdiction over the right of way the hazard exists.
Thank you for participating in the Hazard Reporting Program!