Indiana Road Hazards

INDIANA

ROADHAZARD REPORTING FORM

Thank you for taking the time to let us know about a road hazard you have
encountered or have knowledge of.
Please fill out the following form and complete each section so we may
notify the proper authorities of the hazardous situation.

First name:

Last name:

E-mail:

I live in:

In what state is the hazard located?

In what county is the hazard located?

I was traveling:

North South East West

The roadway is:

The roadway I was on is called:

The closest crossroad to this roadway is called

The hazard I encountered is:

Please explain in detail or give any other details you feel are important about what type of hazard you encountered:

The hazard is located:

Please explain in detail or give any other details you feel are important about where in or near the roadway the hazard you encountered is located:

Comments:

Please give us any other detailed information you feel would help us in locating and identifying the hazard you have brought to our attention:

BEFORE SUBMITTING: Please make sure that all fields have been filled out. Also, please insure all information you have entered is correct before submitting so we may send an accurate and detailed report concerning this hazard to the proper authorities.

( Warning: Pressing reset will erase all fields)

Thank you again for being a part of a massive effort to make our roads, Interstates, streets and highways safer for all motorcycle enthusiasts nationwide. We are planning to expand our efforts as we gather information in the initial phases of the RoadHazard website. Ride safely and spread the word throughout the motorcycling community about our website.

Persistence Marketing, Inc.