Welcome issue

Issue Number as seen Above

Where is the Issue?
—Please choose an option—HospitalStreetCommunitySchoolOthers

[group OtherIssues clear_on_hide inline]
Whats the Other Issue?


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[group Hospital clear_on_hide inline]
Whats Wrong at the Hospital?
—Please choose an option—No medicineNo doctors / nurseRude StaffNot cleanOthers

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[group HospitalName clear_on_hide inline]
Name of Hospital / Clinic


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[group HospitalLocation clear_on_hide inline]
Hospital / Clinic Location


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[group Street clear_on_hide inline]
Whats Wrong in the Streets?
—Please choose an option—Garbage not collectedStreet lights not workingBad roadNot cleanOthers

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[group StreetName clear_on_hide inline]
Name of Street


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[group StreetLocation clear_on_hide inline]
Street Location


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[group Community clear_on_hide inline]
Whats Wrong in the Community?
—Please choose an option—Unclean waterUnsafe electrical wiringsBad roadBad drainageOthers

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[group CommunityName clear_on_hide inline]
Name of Community


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[group CommunityLocation clear_on_hide inline]
Community Location


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[group School clear_on_hide inline]
Whats Wrong at the School?
—Please choose an option—No desksNo teachersUnclean environmentNo books for Pupils/StudentsOthers

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[group SchoolName clear_on_hide inline]
Name of School


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[group SchoolLocation clear_on_hide inline]
School Location


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[cf7mls_step cf7mls_step-1 "Next" "Your Issue to Report"] Your name *

Your Gender *
—Please choose an option—MaleFemalePrefer not to Say
Your Phone Number *

Your Age *

Do you want to Attach photos/videos?
[mfile photo max-file:10]

Should we hide your Identity?
—Please choose an option—YesNo



Note: Before reporting take a screenshot or memorise the Issue number on top. Keep it safe you can use it to track response to your issue, re-report it or give us feedback if the issue has been addressed before we take our actions.

[honeypot email validautocomplete:true move-inline-css:true "Your Email Address"]
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[cf7mls_step cf7mls_step-2 "Back" "Your Details"]

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