@extends('layouts.layout')

@section('content')


<!-- Bootstrap 3.3.7 -->
<link rel="stylesheet" href="{{ URL::asset('css/popup.css') }}">
<style type="text/css">
    /* Style the form */
    #regForm {

    }

    /* Style the input fields */
    input {
        padding: 6px;
        width: 100%;
        font-size: 14px;
        font-family: Raleway;
        border: 1px solid #aaaaaa;
    }

    /* Mark input boxes that gets an error on validation: */
    input.invalid {
        background-color: #ffdddd;
    }

    /* Hide all steps by default: */
    .tab {
        display: none;
    }

    /* Make circles that indicate the steps of the form: */
    .step {
        height: 15px;
        width: 15px;
        margin: 0 2px;
        background-color: #bbbbbb;
        border: none;
        border-radius: 50%;
        display: inline-block;
        opacity: 0.5;
    }

    /* Mark the active step: */
    .step.active {
        opacity: 1;
    }

    /* Mark the steps that are finished and valid: */
    .step.finish {
        background-color: #4CAF50;
    }
</style>
<!-- Content Header (Page header) -->
<section class="content-header">
    <h1>
        {{ ucwords(str_replace('_', ' ', $url)) }} 
        <small>Version 2.0</small>
    </h1>
    <ol class="breadcrumb">
        <li><a href="#"><i class="fa fa-dashboard"></i> SysManager</a></li>
        <!--<li class="active">{{ ucwords(str_replace('_', ' ', $url)) }}</li>-->
    </ol>
</section>


<!-- Main content -->
<section class="content">



    <div class="row">
        <div class="col-xs-12">
            <div class="box" style="padding:10px">



                <form id="regForm" action="">

                    <div style="float:right"><span class="fa fa-save"></span></div>

                    <!-- Beginning of First Tab -->
                    <div class="tab">
                        
                        
                        <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">General Information</h3>
                                    </div>
                                    <div class="panel-body">
                        
                      <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Incident Date</label>
                                <input type="text"  value="" class="form-control required datepicker" id="incident_date" name="incident_date" oninput="this.className = ''"/>

                            </div>
                        </div>
                        
                          <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Time Incident Occurred</label>
                                <input type="time" value="" class="form-control timepicker" id="incident_date" name="incident_date" />

                            </div>
                        </div>
                       
                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Type of Incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select Incident Type</option>
                                     <option value="">Near Miss</option>
                                </select>
                            </div>
                        </div>
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Reporting Organization</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>   
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Client/Charterer</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select Client</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                   
                         
                       
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Region</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select Region</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Country</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select Country</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Shipping Management Organization</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                         
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Operations Based</label>
                                <input type="text" value="" class="form-control" id="incident_date" name="incident_date" />

                            </div>
                        </div>
                                        
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Vessel</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">Adina</option>
                                </select>
                            </div>
                        </div>  
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Contracting Organization</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>               
                                        
                                        
                                        
                          </div><!-- End of Panel Body -->
                            
                        </div><!--  <div class="panel panel-primary setup-content" id="step-1"> -->
                      
                    </div>
                     <!-- End of First Tab --> 
                    

                     
                     
                     
                     
                     
                    <div class="tab">
                          
                        <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">Weather</h3>
                                    </div>
                                    <div class="panel-body">
                        
                    <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Sea Width</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>          
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Sea Height</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>              
                                        
                        
                       <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Current Rate</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                            
                                        
                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Current Direction</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>   
                                        
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Wind Speed</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                          
                                        
                         
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Wind Direction</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                          
                                        
                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Visibility</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                          
                                        
                                        
                          </div>                
                        </div>                  
                    </div>
                            
                            
                            
                            
                            
                    <div class="tab">
                       
                         <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">Person Completing Report At Location</h3>
                                    </div>
                                    <div class="panel-body">
                        
                                            
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Full Name</label>
                                <input type="text" value="" class="form-control" id="incident_date" name="incident_date" />

                            </div>
                        </div>
                                        
                                        
                        <div class="col-sm-4">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Organisation</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                         
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Job Title</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>             
                                        
                                        
                            </div>                     
                         </div>                  
                                      
                    </div>       
                            
                     
                     
                     
                     
                     
                     
                     
                     
                      <div class="tab">
                       
                         <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">Witnesses</h3>
                                    </div>
                                    <div class="panel-body">
                        
                                            
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Full Name</label>
                                <input type="text" value="" class="form-control" id="incident_date" name="incident_date" />

                            </div>
                        </div>
                                        
                                        
                         <div class="col-sm-4">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Organization</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                         
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Job Title</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>               
                                        
                                        
                            </div>                     
                         </div>                  
                                      
                    </div>
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     
                     

                    <div class="tab">
                      
                        <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">Incident Details (<span style="color:#ffffff; background-color:red">Injury/illness</span>)</h3>
                                    </div>
                                    <div class="panel-body">
                        
                                            
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Injured Person Full Name</label>
                                <input type="text" value="" class="form-control" id="incident_date" name="incident_date" />

                            </div>
                        </div>
                                        
                                    
                          <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Organization</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                         
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Job Title</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Type of Injury/illness</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Body Part Harmed</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Task/Activity at time of incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>  
                               
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Location at time of incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Injury/illness Caused By</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Preliminary Classification/Severity </label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div> 
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was Client Advised Of Incident By Contract Manager</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div> 
                                        
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was First Aid Given to Injured Person</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div> 
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was Injured Person Seen By Rig Medic</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was Drug & Alcohol Test Conducted</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                        
                                        
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was Injured Person Evacuated</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>               
                                        
                                        
                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was Injured Person Repatriated</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                
                                        
                                        
                               </div>             
                        </div>                
                    </div>
                     
                     
                     
                     
                     
                     <div class="tab">
                        <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">Incident Details (<span style="color:black; background-color:yellow">Environmental Damage:spill</span>)</h3>
                                    </div>
                                    <div class="panel-body">
                        
                                            
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Type Of Product Spilled</label>
                                <input type="text" value="" class="form-control" id="incident_date" name="incident_date" />

                            </div>
                        </div>
                         
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Task/Activity At Time of Incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                  
                                        
                          
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Location At Time Of Incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Spilled Caused By</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                
                                
                                        
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Preliminary Classification/Severity</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div> 
                                        
                                        
                           
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was Client Advised Of Incident By Contract Manager</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                 
                                        
                                        
                                        
                                        
                                    </div>                
                                        
                        </div>            
                    </div>
                     
                     
                     
                     
                     
                     
                     
                     
                 <div class="tab">
                        <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">Incident Details (<span style="color:darkgreen; background-color:pink">Asset damage/collision</span>)</h3>
                                    </div>
                                    <div class="panel-body">
                        
                                            
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Type Of Damage/Collision</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                         
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Task/Activity At Time of Incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                  
                                        
                          
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Location At Time Of Incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Damaged/Collision Caused By</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                
                                
                                        
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Preliminary Classification/Severity</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div> 
                                        
                                        
                           
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Was Client Advised Of Incident By Contract Manager</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                 
                                        
                                        
                                        
                                        
                                    </div>                
                                        
                        </div>            
                    </div>    
                     
                     
                     
                     
                   
                     
                     
                    <div class="tab">
                        <div class="panel panel-primary setup-content" id="step-1">
                                    <div class="panel-heading">
                                        <h3 class="panel-title">Incident Details (<span style="color:black; background-color:whitesmoke">Near Miss</span>)</h3>
                                    </div>
                                    <div class="panel-body">
                        
                           
                        <div class="row">
                         <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Type Of Potential Injury/Damage/Collision</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                         
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Task/Activity At Time of Incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                  
                                        
                          
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Location At Time Of Incident</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>
                                        
                                        
                                        
                        <div class="col-sm-3">
                            <div class="form-group">
                                <label for="exampleInputEmail1">Near Miss Caused By</label>
                                <select class="form-control" id="incident_type" >
                                    <option value="">Select</option>
                                     <option value="">CIleasing</option>
                                </select>
                            </div>
                        </div>                
                                
                        </div>                
                                        
                         
                         <div class="row">
                        <div class="col-sm-3">
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