Pothole Hazard Report Form

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This Hazard Reporting Form is available to all individuals who wish to report a pothole hazard affecting travelers on City of Santa Cruz streets.
Please correct the field(s) marked in red below:


Contact Information
 *

Hazard Information
 *
Street information
 *
Street information
Direction on street
 *
Direction on street
Please check all that apply:
Please check all that apply:
If construction, please note:
Please comment on how this hazard has impacted you.
Other

Thank you for participating in the Pothole Hazard Reporting Program!

You will receive confirmation of this electronic submission upon completion

  1. To receive a copy of your submission, please fill out your email address below and submit.