2. Report a Concern to Hampton County
4. Use this form to report a concern or make a request.
6. Please use one form per request!
8. Date:*
10. Time:*
12. 
    Contact Information
14. Name*
    -- Select One --Administrator's OfficeAnimal ShelterAssessorAuditorBoard of Elections and Voter RegistrationBuilding & GroundsBuilding Dept. & PermitsCentral Dispatch (E911)Clerk of CourtCode Enforcement (Landfill)Code Enforcement (Veh. Reg.)CoronerCouncil on AgingCounty Council/Clerk to CouncilDelinquent TaxDetention CenterEconomic DevelopmentEmergency PreparednessEmergency ServicesFinanceFire DepartmentGrants AdministrationHuman ResourcesInformation TechnologyLandfill/Solid WasteMagistrate CourtMaintenance ShopProbate CourtRecreation DepartmentRecycling/Solid WasteRisk ManagementRoads & BridgesSheriff's DepartmentTreasurerVeteran's Affairs
16. Phone Number:*
18. Email Address:*
20. 
    Exact Location of Requested Maintenance:
22. Please describe the work being requested:*
24. Location of request:*
26. 
    Maintenance Department Use Only.
28. Purchase Order #:
30. Date Request Received
32. Time Request Received:
34. Parts/Materials Used:
36. Date Completed:
38. Time Completed:
40. Remarks:
42. Work Completed by:
Leave This Blank:


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

    This field is not part of the form submission.

46. Submit Submit and Print

* indicates a required field