* 發現懷疑有問題樹木的日期及時間 : Date and time of identifying the suspected tree problem(s) :
樹木品種(如知道) : Tree species (if known) :
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樹木所在地 : Location of the tree(s) :
*路/區域 : Road / Area :
*地區 : District :
*附近地標 : Near :	(請填寫最接近的街道號碼或燈柱編號) (Please give nearest street number or lamp post number)
*位置 : Position :	度 Degrees 分 Minutes 秒 Seconds   緯度(北) Latitude(N) ° '  "       經度(東) Longitude(E): ° '  "
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樹木出現的問題 (可選多於一項) : Tree problem observed (may tick more than one box) :
出現嚴重傾斜 severe leaning     懸吊斷枝 broken branch(es) hanging from tree   在樹根附近的土壤或建築物出現裂縫 soil cracks or cracks in structures behind the tree     根部因挖掘工程受損 root damage caused by trenching   白蟻 termite     過度修剪 excessive pruning   在樹幹/樹枝上有大型的破損或外露的樹洞 large wound/open cavity on trunk/branch(es)     樹皮剝落 loosened bark 在樹幹/樹枝上有裂開情况 cracks/splits on trunk/branch(es)   有真菌子實體 fungal fruiting bodies observed 枯死枝條或不尋常落葉(例如:在生長季節大量落葉) dead branch(es)/abnormal defoliation   其他補充資料 (請說明) Other supplementary information (please specify)
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現場╱樹木附近有部門標記嗎？ Is there a departmental sign near the site or the tree?
有，請說明 Yes, please specify. 沒有╱看不見 No╱Don't see any.
樹木周圍有下列設施嗎？(例如:籬笆圍欄／花槽／水掣／樹槽／路磚／樹架／樹穴) Are there any facilities around the tree, e.g. fence, trellis, planter, water point, tree pit, paver or tree grill, tree cave?
有 Yes 沒有 No
有關樹木是否整齊排列？ Is the concerned tree(s) arranged in order?
是 Yes 不是 No
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樹木相片(如有的話) : Photos of Tree (if available) : 檔案大小：每個檔案1M bytes 或以下 File size: 1Mbytes or below for each file 相片一 Photo 1 相片二 Photo 2 相片三 Photo 3
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多謝你積極參與，令香港的樹木更安全。 Thank you for your participation in enhancing tree safety in Hong Kong.
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個人資料 (非必要) 政府部門會將以下個人資料作聯絡用途及查詢報告內所載樹木的資料。 Notes about Personal Data (not mandatory) The personal data provided by you below will be used by the relevant Government departments for the purpose of communication with you on matters relating to your report.
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姓名 : Name :
聯絡電話號碼 : Contact telephone no. :
電郵地址 : E-mail address :
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我同意可將本人的聯絡資料轉交有關政府部門，以便跟進及直接聯絡本人。 I agree that my personal contact details may be released to the concerned Government departments to facilitate follow-up actions and communication with me.
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我承認和同意，政府在任何情況下均無須就任何人使用這個網站而引致的直接、間接、特殊的或相應的損失或損害賠償而負責。政府不會保證經互聯網傳送的信息完全可靠。倘本人因經互聯網向當局傳送信息，或因政府應本人的要求經互聯網向本人傳送信息而使本人蒙受損害賠償，政府概不負責。經互聯網傳遞的信息，可能會因互聯網線路繁忙而中斷或傳送受阻，或可能會因互聯網的公開使用或其他原因而將資料錯誤傳送。 I acknowledge and agree that the Government shall not be responsible in any manner for direct, indirect, special or consequential losses or damages howsoever arising out of the use of this website. The Government does not guarantee that any messages sent over the Internet will be completely secure. The Government does not accept any responsibility for any damages incurred by me if I send a message to the Government, or if the Government sends a message to me at my request, over the Internet. Communications over the Internet may be subject to interruption, delayed transmission due to Internet traffic or incorrect data transmission due to the public nature of the Internet or otherwise.   ......................................................................................................................................................................................................
備註: * 必須填寫 Remark : * Mandatory fields
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