Work Order Request

Instructions & Contact Information

To report road-related concerns such as potholes, drainage issues, or overgrown vegetation, please complete this Work Order Request Form. Providing as much detail as possible will help Emanuel County Public Works efficiently evaluate the issue and determine a course of action moving forward.
Form Applicant's Name*
Form Applicant's Address
Form Applicant's Phone Number*
Form Applicant's Email Address
Would you like to be contacted about this work order request?*
1. Yes
1. No
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By submitting this form, you confirm the following:
1. The information provided in this request is accurate to the best of your knowledge.
2. You understand that submitting this request does not guarantee immediate repair or action.
3. You acknowledge that the Emanuel County Road Department will review and prioritize requests based on urgency and available resources.
4. You understand that this form is not intended for reporting emergencies. Any issue that poses an immediate safety risk, such as a washed-out road or debris blocking a roadway, should be reported to 911.
Please indicate your agreement by providing your electronic signature.
Electronic Signature Agreement
By checking the "I agree" box, you agree and acknowledge that your electronic signature is valid and binding upon you to the same force and effect as a handwritten signature.
I Agree*
1. Electronic Signature
Form Applicant Name*
Date*
Date

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