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Citizen Request for Services Form

  1. Use this form to request or report the following: repair of street or potholes, reporting of hazardous sidewalk condition, street or gutter drainage problems, bike paths and catch basin stoppages, street sign issues, traffic signal outage, streetlight outage (provide streetlight pole number). Your name, telephone number, and e-mail address are not required, but are helpful should questions arise.

  2. This Form will help us identify a problem in your area -- and fix it fast. Should a problem require urgent attention, please call us immediately. For a police emergency, dial 911. For Police non-emergencies and animal control issues call 973-680-4141. Otherwise, call Diana at (973) 680-4077 between the hours of 8:30-4:30pm. Thank you for your assistance!

  3. Contact Information

  4. Reported location must be within the Township of Bloomfield Boundaries. The exact reported location/site address is required

  5. Please indicate the nature of your problem by checking the appropriate box(es) below:

  6. Leave This Blank:

  7. This field is not part of the form submission.