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2. Use this form to request or report the following non- emergency issues: repair of street or potholes, reporting of hazardous sidewalk condition, catch basin stoppages, street sign issues, traffic signal outage, streetlight outage (provide streetlight pole number). Your name, telephone number, and e-mail address are not required, but are helpful should questions arise.
4. This form will help us identify a problem in your area -- and fix it fast. Should a problem require urgent attention, please call us immediately. For a police emergency, dial 911. For police non-emergencies, animal control issues or after hours sewer/ drainage problems, call 973-680-4141. Otherwise, call (973) 680-4077 between the hours of 8:30-4:30pm. Thank you for your assistance!
8. Contact Information
9. Upload a picture
11. First Name*
12. Last Name*
14. Phone Number*
15. Email Address
17. Street Address:
19. Reported location must be within the Township of Bloomfield Boundaries. The exact reported location/site address is required
20. Date and Time*
    Date and Time

    Date and Time
22. ISSUE Street Name, Address or Block Number*
24. Please indicate the nature of your problem by checking the appropriate box(es) below:

    1. Pothole
    2. Damaged Curb
    3. Traffic Signal
    4. Weeds
    5. Dog Barking
    6. Abandoned vehicle

    1. Chemical discharge
    2. Water leaking
    3. Litter
    4. Road striping
    5. ADA Complaint
    6. Blocked drainage channel

    1. Street Lights
    2. Damaged Sidewalk
    3. Traffic/Road signs
    4. Overhanging trees/shrubs
    5. Noise nuisance

    1. Hazardous parking
    2. Storm sewer leaking/blockage
    3. Water leaking on roadway
    4. Loose/protruding manhole cover
    5. Illicit storm sewer connection
26. Nearest Two Cross Streets
28. Brief Description (or other problem not listed)*
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field