Incident Report

<form
  action="https://flowqen.com/api/f/YOUR_FORM_ID"
  method="POST"
  class="max-w-lg mx-auto bg-white rounded-2xl shadow-sm border border-gray-200 p-8"
>
  <h2 class="text-xl font-bold text-gray-900 mb-6">Incident Report</h2>

  <div class="space-y-4">
    <div>
      <label class="block text-sm font-medium text-gray-700 mb-1">Reporter</label>
      <input type="text" name="reporterName" class="w-full border border-gray-300 rounded-lg px-4 py-2.5 text-sm focus:outline-none focus:ring-2 focus:ring-[#E14E3A]/20 focus:border-[#E14E3A]" placeholder="John Doe" required />
    </div>

    <div>
      <label class="block text-sm font-medium text-gray-700 mb-1">Date</label>
      <input type="date" name="incidentDate" class="w-full border border-gray-300 rounded-lg px-4 py-2.5 text-sm focus:outline-none focus:ring-2 focus:ring-[#E14E3A]/20 focus:border-[#E14E3A]" required />
    </div>

    <div>
      <label class="block text-sm font-medium text-gray-700 mb-1">Time</label>
      <input type="time" name="incidentTime" class="w-full border border-gray-300 rounded-lg px-4 py-2.5 text-sm focus:outline-none focus:ring-2 focus:ring-[#E14E3A]/20 focus:border-[#E14E3A]" required />
    </div>

    <div>
      <label class="block text-sm font-medium text-gray-700 mb-1">Location</label>
      <input type="text" name="location" class="w-full border border-gray-300 rounded-lg px-4 py-2.5 text-sm focus:outline-none focus:ring-2 focus:ring-[#E14E3A]/20 focus:border-[#E14E3A]" placeholder="Building A" required />
    </div>

    <div>
      <label class="block text-sm font-medium text-gray-700 mb-1">Type</label>
      <select name="incidentType" class="w-full border border-gray-300 rounded-lg px-4 py-2.5 text-sm focus:outline-none focus:ring-2 focus:ring-[#E14E3A]/20 focus:border-[#E14E3A]" required>
        <option value="">Select...</option>
        <option value="Injury">Injury</option>
        <option value="Near miss">Near miss</option>
        <option value="Property damage">Property damage</option>
        <option value="Security breach">Security breach</option>
        <option value="Other">Other</option>
      </select>
    </div>

    <div>
      <label class="block text-sm font-medium text-gray-700 mb-1">Description</label>
      <textarea name="description" rows="4" class="w-full border border-gray-300 rounded-lg px-4 py-2.5 text-sm focus:outline-none focus:ring-2 focus:ring-[#E14E3A]/20 focus:border-[#E14E3A] resize-none" placeholder="What happened..." required></textarea>
    </div>

    <div>
      <label class="block text-sm font-medium text-gray-700 mb-1">Evidence</label>
      <input type="file" name="photo" class="w-full border border-gray-300 rounded-lg px-4 py-2.5 text-sm focus:outline-none focus:ring-2 focus:ring-[#E14E3A]/20 focus:border-[#E14E3A]" required />
    </div>
  </div>

  <!-- Honeypot (spam protection) -->
  <div style="display:none">
    <input type="text" name="_gotcha" style="display:none" />
  </div>

  <button type="submit" class="w-full bg-[#E14E3A] text-white py-3 rounded-lg font-semibold hover:bg-[#c9432f] transition mt-6">
    Submit
  </button>
</form>