{{template "base.html" .}}

{{define "title"}}Dash{{end}}
{{define "style"}}
.district-logo {
	max-height: 60px;
	width: auto;
}

.photo-upload-area {
	border: 2px dashed #ccc;
	border-radius: 8px;
	padding: 20px;
	text-align: center;
	margin-bottom: 20px;
	background-color: #f9f9f9;
}

.photo-preview {
	display: flex;
	flex-wrap: wrap;
	gap: 10px;
	margin-top: 15px;
}

.photo-preview img {
	width: 80px;
	height: 80px;
	object-fit: cover;
	border-radius: 4px;
}

.submit-btn {
	padding: 15px 0;
	font-size: 1.25rem;
	border-radius: 8px;
}

.location-info {
	background-color: #e9f5ff;
	border-radius: 8px;
	padding: 12px;
	margin-bottom: 20px;
	font-size: 0.9rem;
}

@media (max-width: 767px) {
	.header-title {
	font-size: 1.5rem;
	}
}
{{end}}
{{define "content"}}
<!-- Header -->
<header class="bg-light py-2 mb-4">
	<div class="container">
		<div class="row align-items-center">
			<div class="col-9">
				<h1 class="district-name header-title mb-0">[District Name]</h1>
			</div>
			<div class="col-3 text-end">
				<img src="placeholder-logo.png" alt="District Logo" class="district-logo">
			</div>
		</div>
	</div>
</header>

<!-- Main Content -->
<main class="container mb-5">
	<div class="row justify-content-center">
		<div class="col-lg-8">
			<div class="card shadow-sm">
				<div class="card-body p-4">
					<h2 class="card-title text-center mb-4">Quick Mosquito Report</h2>
					
					<!-- Form -->
					<form action="/service-request-quick-confirmation" method="get">
						<!-- Location Automatic Collection Note -->
						<div class="location-info d-flex align-items-center mb-4">
							<svg xmlns="http://www.w3.org/2000/svg" width="20" height="20" fill="currentColor" class="bi bi-geo-alt me-2" viewBox="0 0 16 16">
								<path d="M12.166 8.94c-.524 1.062-1.234 2.12-1.96 3.07A31.493 31.493 0 0 1 8 14.58a31.481 31.481 0 0 1-2.206-2.57c-.726-.95-1.436-2.008-1.96-3.07C3.304 7.867 3 6.862 3 6a5 5 0 0 1 10 0c0 .862-.305 1.867-.834 2.94zM8 16s6-5.686 6-10A6 6 0 0 0 2 6c0 4.314 6 10 6 10z"/>
								<path d="M8 8a2 2 0 1 1 0-4 2 2 0 0 1 0 4zm0 1a3 3 0 1 0 0-6 3 3 0 0 0 0 6z"/>
							</svg>
							<span>Your location and current time will be automatically collected with your report.</span>
						</div>
						
						<!-- Photo Upload -->
						<div class="mb-4">
							<label for="photos" class="form-label fw-bold">Photos (Optional)</label>
							<div class="photo-upload-area">
								<svg xmlns="http://www.w3.org/2000/svg" width="32" height="32" fill="currentColor" class="bi bi-camera mb-2" viewBox="0 0 16 16">
									<path d="M15 12a1 1 0 0 1-1 1H2a1 1 0 0 1-1-1V6a1 1 0 0 1 1-1h1.172a3 3 0 0 0 2.12-.879l.83-.828A1 1 0 0 1 6.827 3h2.344a1 1 0 0 1 .707.293l.828.828A3 3 0 0 0 12.828 5H14a1 1 0 0 1 1 1v6zM2 4a2 2 0 0 0-2 2v6a2 2 0 0 0 2 2h12a2 2 0 0 0 2-2V6a2 2 0 0 0-2-2h-1.172a2 2 0 0 1-1.414-.586l-.828-.828A2 2 0 0 0 9.172 2H6.828a2 2 0 0 0-1.414.586l-.828.828A2 2 0 0 1 3.172 4H2z"/>
									<path d="M8 11a2.5 2.5 0 1 1 0-5 2.5 2.5 0 0 1 0 5zm0 1a3.5 3.5 0 1 0 0-7 3.5 3.5 0 0 0 0 7zM3 6.5a.5.5 0 1 1-1 0 .5.5 0 0 1 1 0z"/>
								</svg>
								<div>
									<input type="file" id="photos" class="d-none" accept="image/*" multiple>
									<button type="button" class="btn btn-outline-primary mb-2" onclick="document.getElementById('photos').click()">Add Photos</button>
								</div>
								<small class="d-block text-muted">Take pictures of the mosquito problem area</small>
								
								<!-- Photo Preview Area (would be populated by JavaScript) -->
								<div class="photo-preview mt-3">
									<!-- Example preview images (these would be dynamically added) -->
									<img src="data:image/svg+xml,%3Csvg xmlns='http://www.w3.org/2000/svg' width='80' height='80' viewBox='0 0 80 80' fill='%23dddddd'%3E%3Crect width='80' height='80' fill='%23eeeeee'/%3E%3Ctext x='50%25' y='50%25' dominant-baseline='middle' text-anchor='middle' font-family='sans-serif' font-size='12' fill='%23999999'%3EPreview%3C/text%3E%3C/svg%3E" alt="Preview">
								</div>
							</div>
						</div>
						
						<!-- Comments -->
						<div class="mb-4">
							<label for="comments" class="form-label fw-bold">Comments</label>
							<textarea class="form-control" id="comments" rows="4" placeholder="Describe the mosquito issue (e.g., standing water, high mosquito activity, time of day they're most active)"></textarea>
						</div>
						
						<!-- Submit Button -->
						<button type="submit" class="btn btn-success w-100 submit-btn mt-4">
							<svg xmlns="http://www.w3.org/2000/svg" width="20" height="20" fill="currentColor" class="bi bi-send-fill me-2" viewBox="0 0 16 16">
								<path d="M15.964.686a.5.5 0 0 0-.65-.65L.767 5.855H.766l-.452.18a.5.5 0 0 0-.082.887l.41.26.001.002 4.995 3.178 3.178 4.995.002.002.26.41a.5.5 0 0 0 .886-.083l6-15Zm-1.833 1.89L6.637 10.07l-.215-.338a.5.5 0 0 0-.154-.154l-.338-.215 7.494-7.494 1.178-.471-.47 1.178Z"/>
							</svg>
							Submit Report
						</button>
					</form>
				</div>
			</div>
			
			<!-- Back Link -->
			<div class="text-center mt-3">
				<a href="javascript:history.back()" class="text-decoration-none">
					<svg xmlns="http://www.w3.org/2000/svg" width="16" height="16" fill="currentColor" class="bi bi-arrow-left me-1" viewBox="0 0 16 16">
						<path fill-rule="evenodd" d="M15 8a.5.5 0 0 0-.5-.5H2.707l3.147-3.146a.5.5 0 1 0-.708-.708l-4 4a.5.5 0 0 0 0 .708l4 4a.5.5 0 0 0 .708-.708L2.707 8.5H14.5A.5.5 0 0 0 15 8z"/>
					</svg>
					Back to home
				</a>
			</div>
		</div>
	</div>
</main>

<!-- Footer -->
<footer class="bg-dark text-white py-3 mt-auto">
	<div class="container">
		<div class="row">
			<div class="col-md-6">
				<p class="mb-0 small">&copy; 2023 [District Name] Mosquito Management District</p>
			</div>
			<div class="col-md-6 text-md-end">
				<p class="mb-0 small">Contact: (555) 123-4567</p>
			</div>
		</div>
	</div>
</footer>
{{end}}