Name-Last name of the informant *

Phone Number *

Address of the informant (if any)

Village/community *

Email (if there)

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   Wood bridge.   Other

Coordinates (if available)

Urgency *

-- Select --GeneralIt's quite urgent. (affects traffic)Very urgent (risk of danger/accident)

Nature of damage (You can choose multiple items) *

 Bridge floor damaged/cracked.

 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 *

Effects that occur (if any)