@extends('app')


<!--**********************************
   lien css ou js -- header
***********************************-->

@section('header')
<link rel="icon" type="image/png" sizes="16x16" href="./images/favicon.png">
<!-- Datatable -->
<link href="{{asset('assets/vendor/jquery-smartwizard/dist/css/smart_wizard.min.css')}}" rel="stylesheet">
<!-- Custom Stylesheet -->
<link href="{{asset('assets/vendor/bootstrap-select/dist/css/bootstrap-select.min.css')}}" rel="stylesheet">
<link href="{{asset('assets/css/style.css')}}" rel="stylesheet">
@endsection

<!--**********************************
   fin lien css ou js -- header
***********************************-->




<!--**********************************
    body
***********************************-->
@section('content')

<div class="container-fluid">
    <!-- Add Project -->
    <div class="modal fade" id="addProjectSidebar">
        <div class="modal-dialog" role="document">
            <div class="modal-content">
                <div class="modal-header">
                    <h5 class="modal-title">Create Project</h5>
                    <button type="button" class="close" data-dismiss="modal"><span>&times;</span>
                    </button>
                </div>
                <div class="modal-body">
                    <form>
                        <div class="form-group">
                            <label class="text-black font-w500">Project Name</label>
                            <input type="text" class="form-control">
                        </div>
                        <div class="form-group">
                            <label class="text-black font-w500">Deadline</label>
                            <input type="date" class="form-control">
                        </div>
                        <div class="form-group">
                            <label class="text-black font-w500">Client Name</label>
                            <input type="text" class="form-control">
                        </div>
                        <div class="form-group">
                            <button type="button" class="btn btn-primary">CREATE</button>
                        </div>
                    </form>
                </div>
            </div>
        </div>
    </div>
    <div class="row page-titles mx-0">
        <div class="col-sm-6 p-md-0">
            <div class="welcome-text">
                <h4>Hi, welcome back!</h4>
                <p class="mb-0">ADD ACCIDENT</p>
            </div>
        </div>
        <div class="col-sm-6 p-md-0 justify-content-sm-end mt-2 mt-sm-0 d-flex">
            <ol class="breadcrumb">
                <li class="breadcrumb-item"><a href="javascript:void(0)">Home</a></li>
                <li class="breadcrumb-item active"><a href="javascript:void(0)">Components</a></li>
            </ol>
        </div>
    </div>
    <!-- row -->
    <div class="row">
        <div class="col-xl-12 col-xxl-12">
            <div class="card">
                <div class="card-header">
                    <h4 class="card-title">ENREGISTRER UN ACCIDENT</h4>
                </div>
                <div class="card-body">
                    <div id="smartwizard" class="form-wizard order-create">
                        <ul class="nav nav-wizard">
                            <li><a class="nav-link" href="#wizard_Service"> 
                                <span>1</span> 
                            </a></li>
                            <li><a class="nav-link" href="#wizard_Time">
                                <span>2</span>
                            </a></li>
                            <li><a class="nav-link" href="#wizard_Details">
                                <span>3</span>
                            </a></li>
                            <li><a class="nav-link" href="#wizard_Payment">
                                <span>4</span>
                            </a></li>
                        </ul>
                        <div class="tab-content">
                            <form action="{{ route('createAccidents') }}" method="post">
                                @csrf

                                <div id="wizard_Service" class="tab-pane" role="tabpanel">
                                    <h3>Information sur l'accident</h3><br><br>
                                    <div class="row">
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">N° Cotisant</label>
                                                <input type="text" name="numCCotisant" class="form-control" >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Nom ou raison sociale</label>
                                                <input type="text" name="raisonSocial" class="form-control"  >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Sigle</label>
                                                <input type="text" class="form-control" id="inputGroupPrepend2" name="sigle" >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Adresse</label>
                                                <input type="text" name="adresse" class="form-control"  >
                                            </div>
                                        </div>
    
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">N° téléphone</label>
                                                <input type="text" name="telephone" class="form-control" >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Fax</label>
                                                <input type="text" name="fax" class="form-control"  >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">E-mail</label>
                                                <input type="email" class="form-control" id="inputGroupPrepend2" name="email" >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Secteur d'activité</label>
                                                <input type="text" name="secteurActivite" class="form-control"  >
                                            </div>
                                        </div>
    
    
    
    
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Nbre de salariés de l'établissement au moment de l'accident</label>
                                                <input type="number" name="nbrSalarieAccident" class="form-control" >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Titre de l'événement</label>
                                                <input type="text" name="titleEvent" class="form-control"  >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Date de l'accident</label>
                                                <input type="date" class="form-control" id="inputGroupPrepend2" name="dateAccident" >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Heure</label>
                                                <input type="time" name="heureAccident" class="form-control"  >
                                            </div>
                                        </div>
    
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Type d'événement</label>
                                                
                                                <select class="form-control" id="event-type" name="type_event_id" >
                                                    <option value="AAA" >AAA</option>
                                                    <option value="ASA" >ASA</option>
                                                    <option value="Incidents" >Incidents</option>
                                                    <option value="Presqu'incidents" >Presqu'incidents</option>
                                                  </select>
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Lieu de l'accident</label>
                                                <input type="text" name="lieuAccident" class="form-control"  >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Horaire de travail dans l'entreprise</label>
                                                <input type="text" class="form-control" id="inputGroupPrepend2" name="horaireTravail" >
                                            </div>
                                        </div>
    
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Nature des lésions</label>
                                                <input type="text" name="natureLesions" class="form-control"  >
                                            </div>
                                        </div>
    
    
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Sièges des lésions</label>
                                                <input type="number" name="siegeLesions" class="form-control" >
                                            </div>
                                        </div>
    
    
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Nom du medecin ou infirmier ayant pratiqué les premiers soins</label>
                                                <input type="text" name="nameMecin" class="form-control"  >
                                            </div>
                                        </div>
    
    
                                        <div class="col-lg-12 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Circonstances détaillées de l'accident</label>
    
                                                <textarea class="form-control" name="detailedCirconstance" id="detailed-circumstances"  ></textarea>
                                            </div>
                                        </div>
    
                                        <div class="col-lg-12 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Cause de l'accident</label>
                                                <input type="text" name="accidentCause" class="form-control"  >
                                            </div>
                                        </div>
    
                                        <div class="col-lg-12 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Suite probable</label>
                                                <input type="text" name="probableSuite" class="form-control"  >
                                            </div>
                                        </div>
    
                                        <div class="mb-3 col-3 form-check">
                                            <label class="radio-inline mr-3"><input type="radio" value="S.A.T" name="sansArretTravail"> Sans arrêt de travail</label>
                                                
                                          </div>
            
                                          <!-- Avec arrêt de travail supérieur à 24 heures -->
                                          <div class="mb-3 col-3 form-check">
                                            <label class="radio-inline mr-3"><input type="radio" value="A.A.T.S" name="sansArretTravail"> Avec arrêt de travail supérieur à 24 heures</label>
                                          </div>
            
                                          <!-- Décès immédiat -->
                                          <div class="mb-3 col-3 form-check">
                                            <label class="radio-inline mr-3"><input type="radio" value="D.I" name="sansArretTravail"> Décès immédiat</label>
                                          </div>
                                          <!-- Nombre de jours d'arrêt -->
                                        <div class="mb-3 col-3">
                                            <label for="stoppage-days" class="form-label">Nombre de jours d'arrêt</label>
                                            <input type="number" class="form-control" id="stoppage-days" name="nbrJrsArret">
                                        </div>
                                    </div>
                                </div>
                                <div id="wizard_Time" class="tab-pane" role="tabpanel">
                                    <h3>Information sur la victimes</h3><br><br>
                                    <div class="row">
                                        <div class="mb-3 col-4">
                                          <label for="social-security-number"
                                            >N° assuré social :</label >
                                          <input type="text" class="form-control" id="social-security-number" name="numAssuranceSocialVictime"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="full-name">Nom et Prénoms :</label>
                                          <input type="text" class="form-control" id="full-name" name="nomPrenomVictime"  />
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label>Sexe :</label>
                                          <div>
                                            <input type="radio" id="male" name="sexeVictime"  value="male" />
                                            <label for="male">Masculin</label>
    
                                            <input type="radio" id="female" name="sexeVictime"  value="female" />
                                            <label for="female">Feminin</label>
                                          </div>
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="address">Adresse :</label>
                                          <input type="text" class="form-control" id="address" name="adresseVictime"  />
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="phone-number">N° téléphone :</label>
                                          <input type="tel" class="form-control" id="phone-number" name="telephoneVictime"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="fax">Fax :</label>
                                          <input type="text" class="form-control" id="fax" name="faxVictime"  />
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="email">E-mail :</label>
                                          <input type="email" class="form-control" id="email" name="emailVictime"  />
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="hiring-date">Date d'embauche :</label>
                                          <input type="date" class="form-control" id="hiring-date" name="dateEmbaucheVictime"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="nationality">Nationalité :</label>
                                          <input type="text" class="form-control" id="nationality" name="nationaliteVictime"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="profession">Profession :</label>
                                          <input type="text" class="form-control"  id="profession"  name="professionVictime"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="job-position"
                                            >Poste de travail :</label
                                          >
                                          <input   type="text" class="form-control" id="job-position"  name="posteTravailVictime"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="seniority"
                                            >Ancienneté au poste :</label
                                          >
                                          <input type="text"  class="form-control"  id="seniority"  name="ancienneteVictime"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="spouse-full-name">Noms et Prénoms (Conjoint/Proche Parent) :</label  >
                                          <input type="text" class="form-control" id="spouse-full-name" name="nomPrenomProche"  />
                                         
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="spouse-phone-number" >N° téléphone :</label >
                                          <input type="tel" class="form-control"  id="spouse-phone-number" name="telephoneProche"  />
                                         
                                        </div>
                                      </div>
                                </div>
                                <div id="wizard_Details" class="tab-pane" role="tabpanel">
                                    <h3>Témoin(s) et tiers Responsable</h3><br><br>
                                    <div class="row">
                                        <h5 class="mb-2  col-lg-12">TEMOIN(S)</h5>
                                        <div class="mb-2 col-lg-6">
                                          <label for="witness-name">Nom(s)/Prénom(s) :</label>
                                          <input type="text" class="form-control"  id="witness-name"  name="nomPrenomTemoin" />
                                          
                                        </div>
            
                                        <div class="mb-2  col-lg-6">
                                          <label for="witness-address">Adresse :</label>
                                          <input type="text" class="form-control"  id="witness-address" name="adresseTemoin" />
                                        </div>
            
                                        <!-- Police Report -->
                                        <div class="mb-3  col-lg-6 row">
                                          <label
                                            >Un rapport de police a-t-il été établi ?</label
                                          >
                                          <div  class="mb-3 col-12 ">
                                            <input
                                              type="radio" id="police-report-yes" name="rapportPoliceExist" alue="oui"/>
                                            <label for="police-report-yes">Oui</label>
                                            <input type="radio" id="police-report-no" name="rapportPoliceExist" value="non" />
                                            <label for="police-report-no">Non</label>
                                          </div>
                                        </div>
            
                                        <div class="mb-3  col-lg-6">
                                          <label for="report-author">Par qui :</label>
                                          <input type="text" class="form-control" id="report-author" name="parQui" />
                                        </div>
            
                                        <h5 class="mb-2  col-lg-12">RISQUE CAUSE PAR UN TIERS</h5>
                                        <div class="mb-3  col-lg-6">
                                          <label for="name">Nom :</label>
                                          <input type="text" class="form-control" id="name" name="nomTiers" />
                                        </div>
            
                                        <div class="mb-3  col-lg-6">
                                          <label for="address">Adresse :</label>
                                          <input type="text" class="form-control" id="address" name="adresseTiers"/>
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="insurance-company" >Cie d'assurances :</label >
                                          <input type="text" class="form-control"  id="insurance-company" name="cieAssuranceTiers" />
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="third-party">du Tiers :</label>
                                          <input type="text" class="form-control" id="third-party" name="duTiers" />
                                        </div>
            
                                        <div class="mb-3 col-4">
                                          <label for="policy-number" >N° de Police d'assurance :</label >
                                          <input type="text" class="form-control" id="policy-number" name="numPoliceAssurance" /> 
                                        </div>
                                      </div>
                                </div>
                                <div id="wizard_Payment" class="tab-pane" role="tabpanel">
                                    <h3>Analyse des causes</h3><br><br>
                                    <div class="row">
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Cause 1</label>
                                                <input type="text" name="cause1" class="form-control"  >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Cause 2</label>
                                                <input type="text" name="cause2" class="form-control" >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Cause 3</label>
                                                <input type="texte" class="form-control" name="cause3">
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Cause 4</label>
                                                <input type="text" name="cause4" class="form-control"  >
                                            </div>
                                        </div>
                                        <div class="col-lg-6 mb-2">
                                            <div class="form-group">
                                                <label class="text-label">Cause 5</label>
                                                <input type="text" name="cause5" class="form-control" >
                                            </div>
                                        </div>
                                    </div><br><br>
                                    <button type="submit" class="btn btn-primary"> ENREGISTRER</button>
    
                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>

@endsection
<!--**********************************
    fin body
***********************************-->






<!--**********************************
    lien js -- footer
***********************************-->
@section('footer')
     <!--  vendors -->

     <!--  vendors -->
    <script src="{{asset('assets/vendor/global/global.min.js')}}"></script>
	<script src="{{asset('assets/vendor/bootstrap-select/dist/js/bootstrap-select.min.js')}}"></script>
    <!-- Datatable -->
    <script src="{{asset('assets/vendor/jquery-steps/build/jquery.steps.min.js')}}"></script>
    <script src="{{asset('assets/vendor/jquery-validation/jquery.validate.min.js')}}"></script>

    <script src="{{asset('assets/js/plugins-init/jquery.validate-init.js')}}"></script>
    <script src="{{asset('assets/vendor/jquery-smartwizard/dist/js/jquery.smartWizard.js')}}"></script>

    <script src="{{asset('assets/js/custom.min.js')}}"></script>
	<script src="{{asset('assets/js/deznav-init.js')}}"></script>
     
@endsection

<!--**********************************
    fin lien  -- footer
***********************************-->