First and last name of the informant *

Telephone number *

Address of the informant (if any)

village/community *

Email (if any)

Convenient time to contact (if any)

-- Select --Morning (08.00-12.00)Afternoon (12.00-16.00)Evening (16.00-20.00)Contact anytime

Bridge name/call name (if any) *

Location/point of problem *

Landmarks/Nearby Places

Bridge type (if known)

 concrete bridge   iron bridge   wooden bridge   Other

Coordinates (if any)

urgency *

-- Select --generalquite urgent (affects traffic)Very urgent (risk of danger/accident)

Nature of damage (You can choose multiple items) *

 Damaged/cracked bridge deck

 Bridge railing damaged/loose

 Structure collapses/tilts

 Bridge pier/base cracked

 The way up and down the bridge is damaged.

 Other

Specify details (in other cases)

Date the damage was discovered *

More details *

Impacts that occur (if any)