Purpose. This form is used to report safety concerns or other issues on a City of Midland street construction project.

First Name:*

Last Name:*

Email:*

Daytime Phone:*

Street:

City:

State / Province:

ZIP / Postal Code:

What street construction issue would you like to report?*

Construction workers not working safe Inappropriate conduct of construction workers Unsafe construction zone

Traffic control problems other

Please provide a detailed description of your concern to help identify the problem:

Please indicate the exact location where the situation was encountered: