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form-report-911.html
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form-report-911.html
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<!DOCTYPE html>
<html>
<head>
<meta http-equiv="Content-type" content="text/html;charset=UTF-8">
<meta name="pack-it-forms-pdf-URL" content="pdf/IncidentReportingFormWithInstructions20231018.pdf">
<link rel="stylesheet" type="text/css" href="resources/css/loading.css"/>
<link rel="stylesheet" type="text/css" href="resources/css/pack-it-forms.css"/>
<link rel="stylesheet" type="text/css" href="resources/css/ics-footer.css"/>
<style>
span.field-number {
padding-left: 0px;
}
table.same-line-label-layout>tr>th,
table.same-line-label-layout>tbody>tr>th {
font-weight: normal;
padding-left: 1em;
text-align: right;
width: 1px;
vertical-align: middle;
}
table.same-line-label-layout>tr>td,
table.same-line-label-layout>tbody>tr>td {
vertical-align: middle;
}
th.label-sameline>label,
td.label-sameline>label {
font-weight: normal;
vertical-align: middle;
}
table.same-line-label-layout>tr>td>input[type="text"],
table.same-line-label-layout>tbody>tr>td>input[type="text"],
table.same-line-label-layout>tr>td>textarea,
table.same-line-label-layout>tbody>tr>td>textarea {
margin-top: 0.2em;
margin-bottom: 0.2em;
}
input[type="checkbox"] {
display: inline;
vertical-align: middle;
}
</style>
<script type="text/javascript" src="resources/js/pack-it-forms.js"></script>
<script type="text/javascript" src="resources/integration/integration.js"></script>
<script type="text/javascript">
function showItems(type, count) {
var i;
var item;
for (i = 1; item = document.getElementById(type + '-' + i); ++i) {
if (i <= count) { // show it:
item.style.removeProperty('display');
} else { // hide it:
item.style.display = 'none';
}
}
var addButton = document.getElementById('add-' + type);
if (addButton) {
if (count < (i - 1)) { // show addButton:
addButton.style.removeProperty('display');
} else { // hide addButton:
addButton.style.display = 'none';
}
}
}
function addItem(type) {
var count = document.getElementById(type + '-count');
var newValue = parseInt(count.value || '0') + 1;
count.value = '' + newValue;
showItems(type, newValue);
formChanged();
return false;
}
integration.after("load_configuration", function() {
ComboBox.getByName("33.reportingLocation").setOptions(
<%#run%>recall('recentReportingLocations')<%/run%>);
ComboBox.getByName("34.reportTaker").setOptions(
<%#run%>recall('recentReportTakers')<%/run%>);
array_for_each(document.querySelectorAll('[name$=".hair"]'), function(item) {
ComboBox.getByName(item.name).setOptions([
"", "Black", "Brown", "Blonde", "Red", "White/Grey", "Bald"
]);
});
array_for_each(document.querySelectorAll('[name$=".structure"]'), function(item) {
ComboBox.getByName(item.name).setOptions([
"", "Single Family", "Condo", "Apartment", "Retail", "Industrial", "Vehicle", "Vegetation"
]);
});
});
// Don't show the 'Add an Item' buttons in a read-only form:
integration.after('late_startup', function() {
if (envelope.readOnly) {
array_for_each(document.querySelectorAll('.print-none'), function(item) {
item.style.display = 'none';
});
}
});
var updateSubject = function() {
document.getElementById("form-subject").value = expand_template(
'{{field:MsgNo}}_{{field:5.handling|truncate:1}}'
+ '_Incident Report_{{field:2c.description|truncate:30}}'
);
};
integration.before('before_submit_new_message', updateSubject);
integration.before('email_message', updateSubject);
</script>
<title>Incident Report (911)</title>
</head>
<body>
<div class="version">1.0</div>
<%#include%>resources/html/loading.html<%/include%>
<form id="the-form" name="the-form">
<table id="scco-banner" class="block-caption noborder">
<tr>
<td style="border:none;padding:4pt 4pt;">
<span style="font-size:150%;">Incident Report (911)</span>
<br/>
<span style="font-size:75%;">Field Numbers Correspond to Instructions on Back of Printed Form</span>
</td>
<td style="border:none;font-weight:normal;padding:2pt 4pt;text-align:right;vertical-align:bottom;">
<span class="templated">PIF: {{version}}</span>
</td>
</tr>
</table>
<span style="display:none;">
<input type="text" name="5.handling" value="IMMEDIATE"/>
</span>
<table class="section">
<tr>
<td>
<table class="same-line-label-layout">
<tr>
<th>Date:<span class="field-number">1</span></th>
<td colspan="3">
<input type="text" name="1a.date" class="date" value="{{date}}" required="required" tabindex="3"/>
<span style="margin-left:0.5em;">Time when incident was observed:<span class="field-number">2</span></span>
<input type="text" name="1b.time" class="time" required="required" tabindex="4"/>
</td>
</tr><tr>
<th>Incident Address:<span class="field-number">3</span></th>
<td colspan="3">
<input name="2a.incident-address" type="text" required tabindex="10"/>
</td>
</tr><tr>
<th>Common Place Name:<span class="field-number">4</span></th>
<td colspan="3">
<input name="2b.common-name" type="text"
placeholder="Senior Center, Home Depot, Cardoza Park, Randall School, etc." tabindex="11"/>
</td>
</tr><tr>
<th>Brief Description:<span class="field-number">5</span></th>
<td colspan="3">
<input name="2c.description" type="text" required tabindex="12"
placeholder="What happened, why is help needed."/>
</td>
</tr><tr>
<th>Reporting Person Name:<span class="field-number">6</span></th>
<td><input name="3a.reporter" type="text" tabindex="13"/></td>
<th>Phone:<span class="field-number">7</span></th>
<td><input name="3b.phone" type="text" class="phone-number" tabindex="14"/></td>
</tr>
</table>
</td>
</tr>
</table>
<!-- START VICTIM -->
<span style="display:none;">
<input type="text" name="6x.victims" id="victim-count" data-default-value="1"
onchange="showItems('victim', parseInt(this.value))"/>
</span>
<table class="section">
<tr>
<td class="block-caption">Victim / Patient</td>
</tr><tr>
<td>
<%#run%>nextFieldNumber = 8; nextTabIndex = 20; include('parts/report-victim.html', {row: "1"});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-victim.html', {row: "2", hr: '<hr/>'});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-victim.html', {row: "3", hr: '<hr/>'});<%/run%>
<div id="add-victim" class="print-none" style="padding:1ex 1.5em;">
<button onclick="return addItem('victim');">
<img src="add_circle_outline_black_18dp.png"
style="vertical-align:-0.33em;width:1.5em;height:1.5em;"/>
Add a Victim / Patient
</button>
</div>
</td>
</tr>
</table>
<!-- START SUSPECT -->
<span style="display:none;">
<input type="text" name="4x.suspect" id="suspect-count" data-default-value="1"
onchange="showItems('suspect', parseInt(this.value))"/>
</span>
<table class="section">
<tr>
<td class="block-caption">Suspect / Subject</td>
</tr><tr>
<td>
<%#run%>nextFieldNumber = 16; include('parts/report-suspect.html', {row: "1"});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-suspect.html', {row: "2", hr: '<hr/>'});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-suspect.html', {row: "3", hr: '<hr/>'});<%/run%>
<div id="add-suspect" class="print-none" style="padding:1ex 1.5em;">
<button onclick="return addItem('suspect');">
<img src="add_circle_outline_black_18dp.png"
style="vertical-align:-0.33em;width:1.5em;height:1.5em;"/>
Add a Suspect / Subject
</button>
</div>
</td>
</tr>
</table>
<!-- START VEHICLE -->
<span style="display:none;">
<input type="text" name="5x.vehicles" id="vehicle-count" data-default-value="1"
onchange="showItems('vehicle', parseInt(this.value))"/>
</span>
<table class="section">
<tr>
<td class="block-caption">Vehicle<span style="font-weight:normal;">,
e.g. hit-and-run or suspect's vehicle.
Not necessary for most traffic accidents.
</span>
</td>
</tr><tr>
<td>
<%#run%>nextFieldNumber = 26; include('parts/report-vehicle.html', {row: "1"});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-vehicle.html', {row: "2", hr: '<hr/>'});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-vehicle.html', {row: "3", hr: '<hr/>'});<%/run%>
<div id="add-vehicle" class="print-none" style="padding:1ex 1.5em;">
<button onclick="return addItem('vehicle');">
<img src="add_circle_outline_black_18dp.png"
style="vertical-align:-0.33em;width:1.5em;height:1.5em;"/>
Add a Vehicle
</button>
</div>
</td>
</tr>
</table>
<!-- START FIRE -->
<span style="display:none;">
<input type="text" name="7x.fire" id="fire-count" data-default-value="1"
onchange="showItems('fire', parseInt(this.value))"/>
</span>
<table class="section">
<tr>
<td class="block-caption">Fire</td>
</tr><tr>
<td>
<%#run%>nextFieldNumber = 32; include('parts/report-fire.html', {row: "1"});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-fire.html', {row: "2", hr: '<hr/>'});<%/run%>
<%#run%>nextFieldNumber = -1; include('parts/report-fire.html', {row: "3", hr: '<hr/>'});<%/run%>
<div id="add-fire" class="print-none" style="padding:1ex 1.5em;">
<button onclick="return addItem('fire');">
<img src="add_circle_outline_black_18dp.png"
style="vertical-align:-0.33em;width:1.5em;height:1.5em;"/>
Add a Fire
</button>
</div>
</td>
</tr>
</table>
<table class="section">
<tr>
<td class="block-caption">Additional Details & City Service Requests</td>
</tr><tr>
<td>
<table class="same-line-label-layout">
<tr>
<th style="vertical-align:top;padding-top:0.5em;">
<span class="field-number">36</span>
</th><td style="padding-bottom:0.25em;">
<textarea name="8.details" rows="4" tabindex="<%nextTabIndex%>"
placeholder="Additional Details and Other 911 Hazard Reporting Examples: electrical wires down, natural gas leak, road blocked, flooding/debris flow, hazardous materials release"
></textarea>
</td>
</tr>
</table>
<table class="same-line-label-layout">
<tr>
<th>
Reporting Location:<span class="field-number">37</span>
</th><td>
<%#run%>include('resources/html/combobox.html', {
name: "33.reportingLocation",
tabindex: "<%&nextTabIndex%>",
attributes: 'placeholder="Fire Station 1, Town Center, Redwood Park, etc."'
})<%/run%>
</td>
</tr><tr>
<th>
Person Taking Report:<span class="field-number">38</span>
</th><td>
<%#run%>include('resources/html/combobox.html', {
name: "34.reportTaker",
tabindex: "<%&nextTabIndex%>",
attributes: 'placeholder="Name, Call Sign or CERT Team #"'
})<%/run%>
</td>
</tr>
</table>
</td>
</tr>
</table>
<div style="page-break-inside:avoid;">
<table class="section">
<tr>
<td colspan="3" class="block-caption">Radio Operator Only:</td>
</tr>
</table><table>
<tr>
<td style="white-space:nowrap;width:1px;vertical-align:middle;">
Message Numbers:
</td><td>
Origin:
<input type="text" name="MsgNo" class="message-number no-msg-init" tabindex="498"
value="{{envelope:sender_message_number}}" required="required"/>
</td><td>
Destination:
<input type="text" class="message-number" disabled="disabled" tabindex="499"
value="{{envelope:receiver_message_number}}"/>
</td>
</tr><tr>
<td style="text-align:right;vertical-align:middle;">
Relay:
</td><td>
<table class="same-line-label-layout">
<tr>
<td style="width:0px;">Rcvd:</td>
<td><input type="text" name="OpRelayRcvd" tabindex="500"/></td>
</tr>
</table>
</td><td>
<table class="same-line-label-layout">
<tr>
<td style="width:0px;">Sent:</td>
<td><input type="text" name="OpRelaySent" tabindex="501"/></td>
</tr>
</table>
</td>
</tr>
</table><table>
<tr>
<td style="padding-right:0;">
<table class="same-line-label-layout">
<tr>
<td style="text-align:right;vertical-align:middle;width:0px;">Name:</td>
<td>
<input type="text" name="OpName" class="no-msg-init include-in-submit" tabindex="502"
disabled="disabled" style="margin-right:0;"
value="{{envelope:viewer_operator_name}}"/>
</td>
</tr>
</table>
</td><td>
Call Sign:
<input type="text" name="OpCall" class="no-msg-init include-in-submit call-sign" tabindex="503"
disabled="disabled" required="required"
value="{{envelope:viewer_operator_call_sign}}"/>
</td><td>
Date:
<input type="text" name="OpDate" class="date no-msg-init init-on-submit" tabindex="504"
disabled="disabled"
value="{{expand-while-null:{{envelope:viewer_date}},{{open-tmpl}}date{{close-tmpl}}}}"/>
</td><td>
Time:
<input type="text" name="OpTime" class="time no-msg-init init-on-submit" tabindex="505"
disabled="disabled"
value="{{expand-while-null:{{envelope:viewer_time}},{{open-tmpl}}time{{close-tmpl}}}}"/>
</td>
</tr>
</table>
</div>
</form>
<%#include%>resources/html/submit-buttons.html<%/include%>
</body>
</html>