251 lines
7.6 KiB
HTML
251 lines
7.6 KiB
HTML
{{ template "rmo/base.html" . }}
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{{ define "title" }}Report Submission Complete{{ end }}
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{{ define "extraheader" }}
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<style></style>
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<script></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
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xmlns="http://www.w3.org/2000/svg"
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width="24"
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height="24"
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fill="currentColor"
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class="bi bi-check-circle-fill me-2"
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viewBox="0 0 16 16"
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>
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<path
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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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/>
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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>
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Please provide your contact information in case the district has
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any follow-up questions.
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</p>
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<form
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id="notificationForm"
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action="/register-notifications"
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method="post"
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class="needs-validation"
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>
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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
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type="text"
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class="form-control"
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id="name"
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maxlength="100"
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name="name"
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placeholder="Adam Smith"
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/>
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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
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xmlns="http://www.w3.org/2000/svg"
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width="16"
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height="16"
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fill="currentColor"
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class="bi bi-envelope"
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viewBox="0 0 16 16"
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>
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<path
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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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/>
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</svg>
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</span>
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<input
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type="email"
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class="form-control"
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id="email"
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maxlength="200"
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name="email"
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placeholder="your@email.com"
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/>
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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
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xmlns="http://www.w3.org/2000/svg"
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width="16"
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height="16"
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fill="currentColor"
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class="bi bi-phone"
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viewBox="0 0 16 16"
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>
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<path
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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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/>
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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
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type="tel"
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class="form-control"
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id="phone"
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maxlength="100"
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name="phone"
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placeholder="(123) 456-7890"
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/>
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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
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class="form-check-input"
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id="consent"
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type="checkbox"
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name="consent"
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checked
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/>
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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
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number above just for the purposes of this report.
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<i
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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."
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></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
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class="form-check-input"
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id="notification"
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type="checkbox"
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name="notification"
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/>
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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
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class="form-check-input"
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id="subscribe"
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type="checkbox"
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name="subscribe"
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/>
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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
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control district.
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{{ else }}
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I'd like to subscribe to periodic updates from
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{{ .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">
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Update report
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</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
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xmlns="http://www.w3.org/2000/svg"
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width="20"
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height="20"
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fill="currentColor"
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class="bi bi-search me-2"
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viewBox="0 0 16 16"
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>
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<path
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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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/>
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</svg>
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Check Your Report Status
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</h4>
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<p>
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You can check the status of your report at any time using your
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Report ID.
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</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 }}"
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><img class="logo" src="{{ .District.URLLogo }}"
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/></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
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xmlns="http://www.w3.org/2000/svg"
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width="16"
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height="16"
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fill="currentColor"
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class="bi bi-plus-circle me-1"
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viewBox="0 0 16 16"
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>
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<path
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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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/>
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<path
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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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/>
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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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