149 lines
6.4 KiB
HTML
149 lines
6.4 KiB
HTML
{{template "base.html" .}}
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{{define "title"}}Report Submission Complete{{end}}
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{{define "extraheader"}}
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<style>
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</style>
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<script>
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</script>
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{{end}}
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{{define "content"}}
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<div class="container py-5">
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<div class="row justify-content-center">
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<div class="col-lg-8">
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<!-- Success Card -->
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<div class="card shadow-sm border-success mb-4">
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<div class="card-header bg-success text-white">
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<h3 class="my-2">
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<svg xmlns="http://www.w3.org/2000/svg" width="24" height="24" fill="currentColor" class="bi bi-check-circle-fill me-2" viewBox="0 0 16 16">
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<path d="M16 8A8 8 0 1 1 0 8a8 8 0 0 1 16 0zm-3.97-3.03a.75.75 0 0 0-1.08.022L7.477 9.417 5.384 7.323a.75.75 0 0 0-1.06 1.06L6.97 11.03a.75.75 0 0 0 1.079-.02l3.992-4.99a.75.75 0 0 0-.01-1.05z"/>
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</svg>
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Report Successfully Submitted
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</h3>
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</div>
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<div class="card-body p-4">
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<div class="text-center mb-4">
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<div class="alert alert-info py-3">
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<strong>Your Report ID:</strong>
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<span class="fs-4 fw-bold">{{.ReportID|publicReportID}}</span>
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</div>
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</div>
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<hr class="my-4">
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<div>
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<h4 class="mb-3">
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<i class="bi bi-person-rolodex"></i>
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Follow-up
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</h4>
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<p>Please provide your contact information in case the district has any follow-up questions.</p>
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<form id="notificationForm" action="/register-notifications" method="post" class="needs-validation">
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<input type="hidden" name="report_id" value="{{.ReportID}}">
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<div class="mb-3">
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<label class="form-label" for="name">Name</label>
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<div class="input-group">
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<span class="input-group-text">
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<i class="bi bi-person-lines-fill"></i>
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</span>
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<input type="text" class="form-control" id="name" name="name" placeholder="Adam Smith">
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</div>
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</div>
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<div class="mb-3">
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<label for="email" class="form-label">Email Address</label>
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<div class="input-group">
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<span class="input-group-text">
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<svg xmlns="http://www.w3.org/2000/svg" width="16" height="16" fill="currentColor" class="bi bi-envelope" viewBox="0 0 16 16">
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<path d="M0 4a2 2 0 0 1 2-2h12a2 2 0 0 1 2 2v8a2 2 0 0 1-2 2H2a2 2 0 0 1-2-2V4Zm2-1a1 1 0 0 0-1 1v.217l7 4.2 7-4.2V4a1 1 0 0 0-1-1H2Zm13 2.383-4.708 2.825L15 11.105V5.383Zm-.034 6.876-5.64-3.471L8 9.583l-1.326-.795-5.64 3.47A1 1 0 0 0 2 13h12a1 1 0 0 0 .966-.741ZM1 11.105l4.708-2.897L1 5.383v5.722Z"/>
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</svg>
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</span>
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<input type="email" class="form-control" id="email" name="email" placeholder="your@email.com">
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</div>
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</div>
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<div class="mb-3">
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<label for="phone" class="form-label">Phone Number</label>
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<div class="input-group">
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<span class="input-group-text">
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<svg xmlns="http://www.w3.org/2000/svg" width="16" height="16" fill="currentColor" class="bi bi-phone" viewBox="0 0 16 16">
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<path d="M11 1a1 1 0 0 1 1 1v12a1 1 0 0 1-1 1H5a1 1 0 0 1-1-1V2a1 1 0 0 1 1-1h6zM5 0a2 2 0 0 0-2 2v12a2 2 0 0 0 2 2h6a2 2 0 0 0 2-2V2a2 2 0 0 0-2-2H5z"/>
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<path d="M8 14a1 1 0 1 0 0-2 1 1 0 0 0 0 2z"/>
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</svg>
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</span>
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<input type="tel" class="form-control" id="phone" name="phone" placeholder="(123) 456-7890">
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</div>
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</div>
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<div class="form-check mb-3 form-check">
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<input class="form-check-input" id="consent" type="checkbox" name="consent" checked>
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<label class="form-check-label" for="consent">
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I consent to being contacted at my email address or phone number above just for the purposes of this report.
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<i class="bi bi-info-circle-fill text-primary ms-1"
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data-bs-toggle="tooltip"
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data-bs-placement="top"
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title="We will never sell your information. We'll send you notifications, but only if you ask us to. We'll share your information with the district that is in change of mosquito control in the area you've reported, but not with anybody else."></i>
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</label>
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</div>
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<div class="form-check mb-3 form-check">
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<input class="form-check-input" id="notification" type="checkbox" name="notification"/>
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<label class="form-check-label" for="notification">
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I'd like to get updates about my report as it gets handled.
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</label>
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</div>
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<div class="form-check mb-3 form-check">
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<input class="form-check-input" id="subscribe" type="checkbox" name="subscribe"/>
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<label class="form-check-label" for="subscribe">
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{{ if eq .District nil }}
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I'd like to subscribe to periodic updates from my mosquito control district.
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{{ else }}
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I'd like to subscribe to periodic updates from {{ .District.Name }}
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{{ end }}
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</label>
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</div>
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<button type="submit" class="btn btn-primary">Update report</button>
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</form>
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</div>
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<hr class="my-4">
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<!-- Status Check Section -->
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<div class="mb-4">
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<h4 class="mb-3">
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<svg xmlns="http://www.w3.org/2000/svg" width="20" height="20" fill="currentColor" class="bi bi-search me-2" viewBox="0 0 16 16">
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<path d="M11.742 10.344a6.5 6.5 0 1 0-1.397 1.398h-.001c.03.04.062.078.098.115l3.85 3.85a1 1 0 0 0 1.415-1.414l-3.85-3.85a1.007 1.007 0 0 0-.115-.1zM12 6.5a5.5 5.5 0 1 1-11 0 5.5 5.5 0 0 1 11 0z"/>
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</svg>
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Check Your Report Status
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</h4>
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<p>You can check the status of your report at any time using your Report ID.</p>
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<a href="/status/{{.ReportID}}" class="btn btn-outline-primary">
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Check Status
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</a>
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</div>
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<div class="row">
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<div class="mb-4 text-center">
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{{ if not (eq .District nil) }}
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<p>Your report will be handled by</p>
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<p><b>{{ .District.Name }}</b></p>
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<a href="{{ .District.URLWebsite }}"><img class="logo" src="{{ .District.URLLogo }}" /></a>
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{{ end }}
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</div>
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</div>
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</div>
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</div>
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<!-- Navigation Links -->
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<div class="text-center">
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<a href="{{ .URL.Nuisance }}" class="btn btn-outline-success">
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<svg xmlns="http://www.w3.org/2000/svg" width="16" height="16" fill="currentColor" class="bi bi-plus-circle me-1" viewBox="0 0 16 16">
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<path d="M8 15A7 7 0 1 1 8 1a7 7 0 0 1 0 14zm0 1A8 8 0 1 0 8 0a8 8 0 0 0 0 16z"/>
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<path d="M8 4a.5.5 0 0 1 .5.5v3h3a.5.5 0 0 1 0 1h-3v3a.5.5 0 0 1-1 0v-3h-3a.5.5 0 0 1 0-1h3v-3A.5.5 0 0 1 8 4z"/>
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</svg>
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Submit Another Report
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</a>
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</div>
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</div>
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</div>
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</div>
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{{end}}
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