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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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Road Information

Type of location in need of repair:*
Select all that apply.
1. Private property
2. Ditch
3. Right-of-way
1. Dirt road
2. Paved road
3. Culvert
1. Bridge
2. Intersection
1. Shoulder
2. Signage
Is your repair request related to damage that may have resulted from Road Department operations? (For example: struck mailbox, damaged landscape, etc.)*
1. Yes
1. No
Location where repairs are required:*
Nearest named area of the county
Additional details about the area:
Provide any specific information that will help the Road Department locate and assess the issue. This could include details such as a section of the road being washed out, nearby landmarks, mile markers, or intersections. The more precise your description, the easier it will be for our team to address the concern promptly.
Have you previously reported an issue in this area?*
1. Yes
2. No
Date of report
Date of report
Please provide the date you initially reported the issue. If you're unsure of the exact date, an approximate date will suffice.
Has the road department addressed this area before?*
1. Yes
2. No
3. I'm not sure
If yes, approximate date when the work was completed:
If yes, approximate date when the work was completed:
Type of repair needed*
Select all that apply.
1. Grade road
2. Pull ditch
3. Apply gravel
4. Clean culvert
1. Clean drainage ditch
2. Install culvert
3. Mow road verge
1. Repair pothole
2. Repair or replace signage
3. Other
Priority of need for repair:*
1. High: Immediate safety risk (e.g., washed-out road, debris blocking road)
1. Moderate: Impacts usability (e.g., potholes, drainage issues)
1. Low: Non-urgent (e.g., faded markings, minor cracks)
Note that high priority issues (or issues that pose an emergency-level safety risk like a washed-out road, a fallen tree blocking the road, or a flooded road) should be reported to 911 immediately.
Reporting these situations to 911 ensures they are logged into the dispatch system and the appropriate parties are sent to address the issue promptly.
This form, and this field specifically, should not be used for reporting purposes in lieu of calling 911.
Life-endangering threats on the roadway are considered emergencies, so call 911!
Photo/Video Upload
You may upload a photo or video to help the road department better understand the need for repair and scope of work.
Accepted file types include JPG, PNG, PDF, and MP4 (video). The maximum file size is 10 MB.
Only relevant photos and videos should be uploaded. Submitting inappropriate or unrelated files is prohibited and may result in further action.
Has this issue been caused by or worsened by recent weather conditions?*
1. Yes
2. No
3. I'm not sure
Estimated date/time of discovery:*
Estimated date/time of discovery:
Estimated date/time of discovery:
Is this road frequently used or critical for access to essential services (schools, hospitals, etc.)?*
1. Yes
2. No
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Acknowledgement Section

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

Leave This Blank:

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

This field is not part of the form submission.
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