Form to report faulty highways equipment

Thank you for taking the trouble to report a fault with a piece of highways equipment. In order to process the fault fully, please fill in the rest of this form with any available supplementary information.

Required information (fields marked as "*" are mandatory.)

Equipment Type
 
Equipment Reference
 
Enter fault Details *
 

Additional information

Name *
 
Email Address *
   
Contact telephone number


Enter the text in the image *