{% extends 'base.html.twig' %}

{% block title %}Command & Control Center — Add Rapid Response Data{% endblock %}

{% block content %}
	<form method="post" class="kt-form">
		<div class="kt-container kt-grid__item kt-grid__item--fluid">
			<div class="kt-portlet kt-portlet--mobile">
				<div class="kt-portlet__head kt-portlet__head--lg">
					<div class="kt-portlet__head-label">
						<h3 class="kt-portlet__head-title">Command &amp; Control Center &mdash; Add Rapid Response Data</h3>
					</div>

					<div class="kt-portlet__head-toolbar">
						<div class="kt-portlet__head-wrapper">
							<a href="{{ path(back_url) }}" class="btn btn-clean btn-icon-sm mr-2"><i class="la la-long-arrow-left"></i>Back</a>
							<input type="reset" class="btn btn-secondary btn-bold mr-2">
							<button class="btn btn-primary btn-bold">Submit</button>
						</div>
					</div>
				</div>

				<div class="kt-portlet__body">
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Type of emergency/Disease</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Out break No,</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Team No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Head of Team</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Team Member 1 </label>
						<div class="col-lg-9 col-xl-6">
							<select class="form-control">
								<option value="emp1">Employee 1</option>
								<option value="emp2">Employee 2</option>
								<option value="emp3">Employee 3</option>
							</select>
						</div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Email & Phone No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Team Member 2 </label>
						<div class="col-lg-9 col-xl-6">
							<select class="form-control">
								<option value="emp1">Employee 1</option>
								<option value="emp2">Employee 2</option>
								<option value="emp3">Employee 3</option>
							</select>
						</div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Email & Phone No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Team Member 3 </label>
						<div class="col-lg-9 col-xl-6">
							<select class="form-control">
								<option value="emp1">Employee 1</option>
								<option value="emp2">Employee 2</option>
								<option value="emp3">Employee 3</option>
							</select>
						</div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Email & Phone No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Team Member 4 </label>
						<div class="col-lg-9 col-xl-6">
							<select class="form-control">
								<option value="emp1">Employee 1</option>
								<option value="emp2">Employee 2</option>
								<option value="emp3">Employee 3</option>
							</select>
						</div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Email & Phone No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Team Member 5 </label>
						<div class="col-lg-9 col-xl-6">
							<select class="form-control">
								<option value="emp1">Employee 1</option>
								<option value="emp2">Employee 2</option>
								<option value="emp3">Employee 3</option>
							</select>
						</div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Email & Phone No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Team Member 6 </label>
						<div class="col-lg-9 col-xl-6">
							<select class="form-control">
								<option value="emp1">Employee 1</option>
								<option value="emp2">Employee 2</option>
								<option value="emp3">Employee 3</option>
							</select>
						</div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Email & Phone No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Vehilce No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Driver name</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Contact No.</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Upload reports</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="file"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Upload photo</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="file"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Upload photo</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="file"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Upload photo</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="file"></div>
					</div>
					<div class="form-group row">
						<label class="col-xl-3 col-lg-3 font-weight-bold">Modify</label>
						<div class="col-lg-9 col-xl-6"><input class="form-control" type="text"></div>
					</div>
				</div>
			</div>
		</div>
	</form>
{% endblock %}