Contact Report Form

Complete this form when you have been contacted by outside sources such as the media or a legislator. An email will be generated to alert management and other staff across the DOT to topics that are of interest to key stakeholders or items that might appear in the news.

If you would like to be added to the list to receive contact reports, please send an email to DOT-webteam@iowadot.us. Be sure to include the type of contact reports you would like to receive - media, state legislator, congressional member, Governor/Lt. Governor, Ombudsman, or any other contact.

Type of contact*

Date contacted*

Submitted by

Your full name*

Your email address *

We will send a copy of your contact report to this email address. This report is automatically sent to key management and other contacts across the DOT. If there is someone else you would like to receive your report, you can forward the copy that will be sent to you.

Bureau/Division*

Subject of contact*

Contacted by

Enter as much contact information that you have available about the individual who contacted you.

Contacted by (name)*

Business/Office

City

State

Phone number

Email address

Summarize your discussion. Please include details that may generate interest for the press, lawmakers, key stakeholders or the general public or has the potential to create negative or extremely positive attention for the agency. *

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Is any additional follow-up required?

YesNo

Attachments

Add up to five attachments you provided the contact to support your discussion.

Must be one of the following file formats: .png, .jpg, .gif, .pdf, .docx, .doc ,.xlsx, .ppt, .pptx

The total size of all attachments must be less than 10MB.

Add attachment

Iowa DOT Employees