Form templates / Government & Public Services
Service Request Form
A service request form is how a resident reports a pothole, a broken light or a fly-tip. Its whole value is a location precise enough to send someone to.
For councils, agencies and public-sector teams.
A location, not an address
"The streetlight on Mill Lane" is not actionable when Mill Lane has forty of them. What a crew needs is the nearest house number, the pole number if visible, or a landmark - and residents give it happily when asked directly.
So this template asks for the street plus a locator, and prompts for what to look for. It also asks about urgency in terms of safety rather than annoyance, which is what actually determines the response time - and it says so, so nobody expects a same-day visit for a faded line marking.
The same facts, every time
When each report is written differently, patterns are invisible. Consistent fields mean you can look across a month and see the thing that keeps happening, rather than a folder of prose.
Accessible to everyone, including the people without an app
A public form has to work for the resident on a six-year-old Android with 200 MB of data left, and for the one using a screen reader. That rules out most modern form builders, which need JavaScript to render a text box.
These pages are ordinary HTML with real labels and native controls: they work with assistive technology, keyboard only, and with scripting switched off entirely.
Easy enough to actually be used
A reporting process nobody follows produces no data. This one is a link that opens instantly on a phone and takes a couple of minutes, which is the only version that gets used on a busy day.
One minute to make it your own
Every label, option and placeholder on this template is editable, and you can add whatever this template doesn't ask. Save to publish, share the link, and export the responses whenever you need them in a spreadsheet.
What this template asks
- What are you reporting?
- Street name
- Nearest house number, pole number or landmark
- Postcode, if known
- Describe the problem
- A link to a photo, if you have one
- Is it causing a safety risk?
- Have you reported this before?
- Your name
- Email address
- Phone number
- Let me know when this is resolved
More Government & Public Services forms
Questions
Can residents send photos?
Yes - a file question takes up to three photos at 20 MB each, which is the fastest way to identify a problem. The descriptive details instead. The location fields do most of the work a photo would.
Can we route different issue types to different teams?
Notifications go to the addresses you choose, and the issue type appears in the email, so a single triage inbox can route each one correctly in seconds.
Can reports be submitted anonymously?
Yes, if you make the name optional. Nothing about the submitter is recorded otherwise - no IP address, no account, no tracking.
Can this go to more than one person?
Yes. Notification recipients are a list, so a report can reach a manager and a safety lead at the same time.
Can I export everything for an audit?
Yes - one click gives you a CSV of every response with its timestamp, which is usually exactly what an auditor or insurer asks for.
Is it accessible, and does it track people?
Forms use semantic HTML, real labels, keyboard-navigable native controls and work without JavaScript. No cookies, no analytics scripts and no IP logging - so there's no consent banner between a resident and a public service.
Publish your service request form today
Start from this template and change anything you like. Free to begin.