Request for Assistance

Maintenance Service Requests are handled Monday through Friday, 7:30 AM to 5:00 PM. This form should NOT be used to report any kind of highway emergency or criminal activity. Report highway emergencies to 911 or the local State Police.

Fields marked with * are required.

Please submit the form only one time for each issue.

Location Information
County Where Assistance is Requested:
*
Route Number:
*
(If available, can be obtained from the DOH road sign)
Road Name:
*
Landmark:
*
GPS Information

Use the map to find the location of the request. Clicking the map will drop a marker and update the GPS Latitude, Longitude. (Don't worry if you drop a marker accidently, the GPS Latitude, Longitude will update with every click)


GPS Latitude, Longitude:

Description of Issue (Be as specific as possible):

*

Would you like to be contacted concerning your issue?
Yes
Your Information
Your First Name:
Your Last Name:
Your Email Address:
Your Mailing Address:
Your Phone Number:


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