Technical Fault Reporting Webpage

I'm looking to develop a fault reporting webpage specifically for technical faults. All data should be stored in a database.

Requirements:
- Collect the following information for each fault report:
- Fault description
- Time and date of occurrence
- Photos of the fault
- User email ID
- Actions to be taken after a fault is reported:
- Notify admin immediately
- Send confirmation to user
- Log the report for later review

Ideal Skills and Experience:
- Proficiency in web development
- Experience with database management
- Familiarity with real-time notification systems
- Strong UI/UX design skills for user-friendly interfaces