diff options
Diffstat (limited to 'templates/website')
| -rw-r--r-- | templates/website/questionnaire | 34 |
1 files changed, 34 insertions, 0 deletions
diff --git a/templates/website/questionnaire b/templates/website/questionnaire new file mode 100644 index 000000000..869552c4b --- /dev/null +++ b/templates/website/questionnaire @@ -0,0 +1,34 @@ +{{ $map_start }} + +<h1>{{ $heading }}</h1> + +<form method="post" action="{{ $form_action }}" id="questionnaire"{{ $enctype }}> +<input type="hidden" name="token" value="{{ $input_h{token} }}"> + +{{ $blurb_eh }} + +<p>{{ $blurb_report }} {{ $blurb_report2 }}</p> + +{{ $errors }} + +<p>{{ $fixed_question }}</p> +<p> +<input type="radio" name="been_fixed" id="been_fixed_yes" value="Yes"{{ $been_fixed{yes} }}> +<label for="been_fixed_yes">{{ $yes }}</label> +<input type="radio" name="been_fixed" id="been_fixed_no" value="No"{{ $been_fixed{no} }}> +<label for="been_fixed_no">{{ $no }}</label> +<input type="radio" name="been_fixed" id="been_fixed_unknown" value="Unknown"{{ $been_fixed{unknown} }}> +<label for="been_fixed_unknown">{{ $dontknow }}</label> +</p> + +{{ $ever_reported }} + +{{ $blurb_update }} +<p><textarea name="update" style="max-width:90%" rows="7" cols="30">{{ $input_h{update} }}</textarea></p> +{{ $photo_input }} + +{{ $another_questionnaire }} + +<p><input type="submit" name="submit" value="{{ $submit }}"></p> </form> + +{{ $map_end }} |