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2. Name of Park or Playground
4. Playgrounds

   1. Safety Fiber/Wood Chips
   2. Weeds
   3. Equipment
   4. Graffiti
   5. Other
5. Picnic Tables & Benches

   1. Broken Boards
   2. Graffiti
   3. Frame Bent
   4. Other
7. Trash Receptacles

   1. Graffiti
   2. Need Emptied
   3. Trash Liner
8. Open Shelter

   1. Graffiti
   2. Tables
   3. Trash Recepticals
   4. Other
10. Park Sign & Landscaping Beds

    1. Weeds
    2. Graffiti
    3. Planter Box Repair
    4. Other
11. Basketball Hoop & Court

    1. Crank Assembly
    2. Backboard
    3. Net
    4. Graffiti
    5. Other
13. Restrooms

    1. Facility Repair Needed
    2. Vandalism
    3. Graffiti
    4. Supplies
14. Tree Issues

    1. Hanging Limbs
    2. Trimming
    3. Hazard Issue
16. If you notice something that is a safety or maintenance issue, or you are not able to address it yourself – don’t wait! Please contact the Parks & Recreation office immediately (hanging branches, broken equipment, fallen trees, excess garbage, etc.)
18. Other Items or Concerns
20. First & Last Name*
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