nidus-sync/public-report/template/pool.html

{{template "base.html" .}}

{{define "title"}}Green Pool{{end}}
{{define "extraheader"}}
{{template "location-geocode-header" .}}
{{template "map-header" .}}
{{template "photo-upload-header"}}
<style>
.district-logo {
	max-height: 80px;
	width: auto;
}
.map-container {
	height: 500px;
	background-color: #e9ecef;
	border-radius: 5px;
	border: 1px solid #dee2e6;
	display: flex;
	align-items: center;
	justify-content: center;
	margin-top: 10px;
}
.form-section {
	margin-bottom: 2.5rem;
	padding-bottom: 2rem;
	border-bottom: 1px solid #dee2e6;
}
.form-section:last-child {
	border-bottom: none;
	margin-bottom: 1rem;
	padding-bottom: 0;
}
.section-heading {
	margin-bottom: 1.5rem;
	display: flex;
	align-items: center;
}
.section-heading i {
	margin-right: 10px;
	font-size: 1.5rem;
	color: #0d6efd;
}
.optional-label {
	font-size: 0.875rem;
	color: #6c757d;
	font-weight: normal;
	margin-left: 8px;
}
.submit-container {
	background-color: #f8f9fa;
	padding: 20px;
	border-radius: 5px;
	margin-top: 2rem;
}
</style>
{{end}}
{{define "content"}}
<!-- Main Content -->
<main class="py-5">
	<div class="container">
		<!-- Page Title -->
		<div class="row mb-4">
			<div class="col-12">
				<h2>Report a Green Pool or Mosquito Source</h2>
				<p class="lead">Help us locate and treat potential mosquito breeding sources in your area</p>
			</div>
		</div>

		<!-- Info Alert -->
		<div class="row mb-4">
			<div class="col-12">
				<div class="alert alert-info" role="alert">
					<h5 class="alert-heading"><i class="bi bi-info-circle me-2"></i>All fields are optional</h5>
					<p class="mb-0">We appreciate any information you can provide. The more details you share, the better we can address the issue. Photos and location information are especially helpful.</p>
				</div>
			</div>
		</div>

		<!-- Report Form -->
		<form id="greenPoolForm">
			<!-- Photo Upload Section -->
			<div class="form-section">
				<div class="section-heading">
					<i class="bi bi-camera"></i>
					<h3>Photos</h3>
					<span class="optional-label">optional</span>
				</div>
				<p class="mb-3">Photos help us identify the severity of the issue and may contain location data that can help us find the source.</p>
				
				{{template "photo-upload"}}
			</div>

			<!-- Location Section -->
			<div class="form-section">
				<div class="section-heading">
					<i class="bi bi-geo-alt"></i>
					<h3>Location</h3>
					<span class="optional-label">optional</span>
				</div>
				<p class="mb-3">Please provide the location of the potential mosquito breeding source. We may be able to extract this information from your photos if they contain location data.</p>
				
				<div class="row mb-3">
					<div class="col-md-12">
						{{template "location-geocode"}}
					</div>
				</div>
				
				<p class="small text-muted mb-2">You can also click on the map to mark the location precisely</p>
				<div class="map-container">
					<div id="map"></div>
				</div>
			</div>

			<!-- Source Details Section -->
			<div class="form-section">
				<div class="section-heading">
					<i class="bi bi-water"></i>
					<h3>Source Details</h3>
					<span class="optional-label">optional</span>
				</div>
				
				<div class="row mb-4">
					<div class="col-md-6">
						<label for="duration" class="form-label">How long has this source been present?</label>
						<select class="form-select" id="duration">
							<option value="">I don't know</option>
							<option value="less-than-week">Less than a week</option>
							<option value="1-2-weeks">1-2 weeks</option>
							<option value="2-4-weeks">2-4 weeks</option>
							<option value="1-3-months">1-3 months</option>
							<option value="more-than-3-months">More than 3 months</option>
						</select>
					</div>
					
					<div class="col-md-6">
						<label class="form-label d-block">Have you observed any of the following? <a href="#" data-bs-toggle="modal" data-bs-target="#larvaeInfoModal"><i class="bi bi-question-circle small ms-1"></i></a></label>
						<div class="form-check">
							<input class="form-check-input" type="checkbox" id="larvae">
							<label class="form-check-label" for="larvae">
								Larvae (wigglers) in water
							</label>
						</div>
						<div class="form-check">
							<input class="form-check-input" type="checkbox" id="pupae">
							<label class="form-check-label" for="pupae">
								Pupae (tumblers) in water
							</label>
						</div>
						<div class="form-check">
							<input class="form-check-input" type="checkbox" id="adultMosquitoes">
							<label class="form-check-label" for="adultMosquitoes">
								Adult mosquitoes near the source
							</label>
						</div>
					</div>
				</div>
			</div>

			<!-- Access Information Section -->
			<div class="form-section">
				<div class="section-heading">
					<i class="bi bi-unlock"></i>
					<h3>Access Information</h3>
					<span class="optional-label">optional</span>
				</div>
				<p class="mb-3">Please provide any details about how to access the mosquito source. This helps our technicians when they visit the site.</p>
				
				<div class="row mb-3">
					<div class="col-md-12">
						<label for="accessInfo" class="form-label">How can the source be accessed?</label>
						<textarea class="form-control" id="accessInfo" rows="3" placeholder="Example: The pool is in the backyard, which can be accessed through a side gate on the right side of the house."></textarea>
					</div>
				</div>
				
				<div class="row mb-3">
					<div class="col-md-12">
						<label class="form-label d-block">Access obstacles (check all that apply):</label>
						<div class="row">
							<div class="col-md-4">
								<div class="form-check">
									<input class="form-check-input" type="checkbox" id="gate">
									<label class="form-check-label" for="gate">Gate</label>
								</div>
								<div class="form-check">
									<input class="form-check-input" type="checkbox" id="fence">
									<label class="form-check-label" for="fence">Fence</label>
								</div>
							</div>
							<div class="col-md-4">
								<div class="form-check">
									<input class="form-check-input" type="checkbox" id="lockedEntrance">
									<label class="form-check-label" for="lockedEntrance">Locked entrance</label>
								</div>
								<div class="form-check">
									<input class="form-check-input" type="checkbox" id="dogs">
									<label class="form-check-label" for="dogs">Dogs/pets</label>
								</div>
							</div>
							<div class="col-md-4">
								<div class="form-check">
									<input class="form-check-input" type="checkbox" id="otherObstacle">
									<label class="form-check-label" for="otherObstacle">Other obstacle</label>
								</div>
							</div>
						</div>
					</div>
				</div>
			</div>

			<!-- Contact Information Sections -->
			<div class="form-section">
				<div class="section-heading">
					<i class="bi bi-person-lines-fill"></i>
					<h3>Contact Information</h3>
					<span class="optional-label">optional</span>
				</div>
				
				<!-- Property Owner Information -->
				<h5 class="mb-3">Property Owner Information (if known)</h5>
				<div class="row mb-4">
					<div class="col-md-6 mb-3">
						<label for="ownerName" class="form-label">Owner Name</label>
						<input type="text" class="form-control" id="ownerName">
					</div>
					<div class="col-md-6 mb-3">
						<label for="ownerPhone" class="form-label">Owner Phone</label>
						<input type="tel" class="form-control" id="ownerPhone">
					</div>
					<div class="col-md-12">
						<label for="ownerEmail" class="form-label">Owner Email</label>
						<input type="email" class="form-control" id="ownerEmail">
					</div>
				</div>
				
				<!-- Your Contact Information -->
				<h5 class="mb-3">Your Contact Information (for updates)</h5>
				<div class="row mb-3">
					<div class="col-md-6 mb-3">
						<label for="reporterName" class="form-label">Your Name</label>
						<input type="text" class="form-control" id="reporterName">
					</div>
					<div class="col-md-6 mb-3">
						<label for="reporterPhone" class="form-label">Your Phone</label>
						<input type="tel" class="form-control" id="reporterPhone">
					</div>
					<div class="col-md-12 mb-3">
						<label for="reporterEmail" class="form-label">Your Email</label>
						<input type="email" class="form-control" id="reporterEmail">
					</div>
					<div class="col-md-12">
						<div class="form-check">
							<input class="form-check-input" type="checkbox" id="receiveUpdates" checked>
							<label class="form-check-label" for="receiveUpdates">
								I would like to receive updates on this report
							</label>
						</div>
					</div>
				</div>
			</div>

			<!-- Additional Information Section -->
			<div class="form-section">
				<div class="section-heading">
					<i class="bi bi-card-text"></i>
					<h3>Additional Information</h3>
					<span class="optional-label">optional</span>
				</div>
				<p class="mb-3">Please provide any other information that might help us address this mosquito source.</p>
				
				<div class="row">
					<div class="col-md-12">
						<label for="additionalInfo" class="form-label">Additional Details</label>
						<textarea class="form-control" id="additionalInfo" rows="4" placeholder="Example: The house appears to be vacant. There is algae growth in the pool. I've noticed increased mosquito activity in the evenings."></textarea>
					</div>
				</div>
			</div>

			<!-- Submit Section -->
			<div class="submit-container">
				<div class="row align-items-center">
					<div class="col-md-8">
						<p class="mb-0"><strong>Thank you for helping us keep our community safe from mosquito-borne illnesses.</strong></p>
						<p class="mb-0 small text-muted">After submission, you will receive a confirmation with a report ID for tracking purposes.</p>
					</div>
					<div class="col-md-4 text-md-end mt-3 mt-md-0">
						<button type="submit" class="btn btn-primary btn-lg">
							Submit Report
						</button>
					</div>
				</div>
			</div>
		</form>

		<!-- Back Button -->
		<div class="row mt-4">
			<div class="col-12">
				<a href="/" class="btn btn-outline-secondary">
					<i class="bi bi-arrow-left"></i> Back to Home
				</a>
			</div>
		</div>
	</div>
</main>

<!-- Larvae Info Modal -->
<div class="modal fade" id="larvaeInfoModal" tabindex="-1" aria-labelledby="larvaeInfoModalLabel" aria-hidden="true">
	<div class="modal-dialog modal-lg">
		<div class="modal-content">
			<div class="modal-header">
				<h5 class="modal-title" id="larvaeInfoModalLabel">How to Identify Mosquito Larvae and Pupae</h5>
				<button type="button" class="btn-close" data-bs-dismiss="modal" aria-label="Close"></button>
			</div>
			<div class="modal-body">
				<div class="row mb-4">
					<div class="col-md-6">
						<h6>Mosquito Larvae (Wigglers)</h6>
						<p>Mosquito larvae, often called "wigglers," are:</p>
						<ul>
							<li>Small, worm-like aquatic organisms</li>
							<li>Usually 1/4 to 1/2 inch long</li>
							<li>Move with a wiggling motion in water</li>
							<li>Hang upside-down at the water surface to breathe</li>
							<li>Visible to the naked eye in standing water</li>
						</ul>
					</div>
					<div class="col-md-6">
						<h6>Mosquito Pupae (Tumblers)</h6>
						<p>Mosquito pupae, often called "tumblers," are:</p>
						<ul>
							<li>Comma-shaped organisms</li>
							<li>Typically darker than larvae</li>
							<li>Move with a tumbling motion when disturbed</li>
							<li>Rest at the water surface</li>
							<li>The stage just before adult mosquitoes emerge</li>
						</ul>
					</div>
				</div>
				<p>When looking for mosquito larvae and pupae, check standing water sources like:</p>
				<ul>
					<li>Swimming pools</li>
					<li>Bird baths</li>
					<li>Buckets or containers</li>
					<li>Drainage ditches</li>
					<li>Plant saucers</li>
					<li>Rain gutters</li>
				</ul>
				<p>If you see small creatures moving in standing water, there's a good chance they're mosquito larvae or pupae.</p>
				<div class="text-center">
					<a href="#" class="btn btn-outline-primary">View Detailed Identification Guide</a>
				</div>
			</div>
			<div class="modal-footer">
				<button type="button" class="btn btn-secondary" data-bs-dismiss="modal">Close</button>
			</div>
		</div>
	</div>
</div>
{{end}}