{"id":52,"date":"2021-08-24T14:33:52","date_gmt":"2021-08-24T14:33:52","guid":{"rendered":"https:\/\/nearmiss.dutil.com\/?page_id=52"},"modified":"2021-08-24T14:46:12","modified_gmt":"2021-08-24T14:46:12","slug":"near-miss-submission-2","status":"publish","type":"page","link":"https:\/\/nearmiss.dutil.com\/","title":{"rendered":"Near Miss Submission"},"content":{"rendered":"<div class=\"frm_forms  with_frm_style frm_style_formidable-style\" id=\"frm_form_3_container\" >\n<form enctype=\"multipart\/form-data\" method=\"post\" class=\"frm-show-form \" id=\"form_nearmiss90447333e6\"  >\n<div class=\"frm_form_fields \">\n<fieldset>\n<legend class=\"frm_screen_reader\">NearMissv2<\/legend>\r\n\r\n<div class=\"frm_fields_container\">\n<input type=\"hidden\" name=\"frm_action\" value=\"create\" \/>\n<input type=\"hidden\" name=\"form_id\" value=\"3\" \/>\n<input type=\"hidden\" name=\"frm_hide_fields_3\" id=\"frm_hide_fields_3\" value=\"\" \/>\n<input type=\"hidden\" name=\"form_key\" value=\"nearmiss90447333e6\" \/>\n<input type=\"hidden\" name=\"item_meta[0]\" value=\"\" \/>\n<input type=\"hidden\" id=\"frm_submit_entry_3\" name=\"frm_submit_entry_3\" value=\"f3473f207f\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php?rest_route=%2Fwp%2Fv2%2Fpages%2F52\" \/><div id=\"frm_field_15_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_fpwfd1866b8dc12\" id=\"field_fpwfd1866b8dc12_label\" class=\"frm_primary_label\">Date of near-miss\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_fpwfd1866b8dc12\" name=\"item_meta[15]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_16_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_i9snmfe7db021e3\" id=\"field_i9snmfe7db021e3_label\" class=\"frm_primary_label\">Time of near-miss\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_i9snmfe7db021e3\" name=\"item_meta[16]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_17_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_w3320090a08e669\" id=\"field_w3320090a08e669_label\" class=\"frm_primary_label\">Location\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_w3320090a08e669\" name=\"item_meta[17]\" value=\"\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_18_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_syqhs5a457274aa\" id=\"field_syqhs5a457274aa_label\" class=\"frm_primary_label\">Name (Not Required)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_syqhs5a457274aa\" name=\"item_meta[18]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_19_container\" class=\"frm_form_field form-field  frm_top_container\">\r\n    <label for=\"field_gahu59abb3ddacd\" id=\"field_gahu59abb3ddacd_label\" class=\"frm_primary_label\">Department (Not Required)\r\n        <span class=\"frm_required\"><\/span>\r\n    <\/label>\r\n    <input type=\"text\" id=\"field_gahu59abb3ddacd\" name=\"item_meta[19]\" value=\"\"  data-invmsg=\"Text is invalid\" aria-invalid=\"false\"  \/>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_20_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container vertical_radio\">\r\n    <div  id=\"field_qvihk2a0f33cddc_label\" class=\"frm_primary_label\">Potential Severity of Near Miss \r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/div>\r\n    <div class=\"frm_opt_container\" aria-labelledby=\"field_qvihk2a0f33cddc_label\" role=\"group\">\t\t<div class=\"frm_radio\" id=\"frm_radio_20-0\"><label for=\"field_qvihk2a0f33cddc-0\">\t\t<input type=\"radio\" name=\"item_meta[20]\" id=\"field_qvihk2a0f33cddc-0\" value=\"Minor Severity\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Potential Severity of Near Miss  is invalid\" aria-invalid=\"false\"  \/> Minor Severity<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_20-1\"><label for=\"field_qvihk2a0f33cddc-1\">\t\t<input type=\"radio\" name=\"item_meta[20]\" id=\"field_qvihk2a0f33cddc-1\" value=\"Moderate Severity\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Potential Severity of Near Miss  is invalid\" aria-invalid=\"false\"  \/> Moderate Severity<\/label><\/div>\n\t\t<div class=\"frm_radio\" id=\"frm_radio_20-2\"><label for=\"field_qvihk2a0f33cddc-2\">\t\t<input type=\"radio\" name=\"item_meta[20]\" id=\"field_qvihk2a0f33cddc-2\" value=\"High Severity\"\n\t\t   data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Potential Severity of Near Miss  is invalid\" aria-invalid=\"false\"  \/> High Severity<\/label><\/div>\n<\/div>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_21_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_6ubogb0f6c48e02\" id=\"field_6ubogb0f6c48e02_label\" class=\"frm_primary_label\">Description of near-miss\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[21]\" id=\"field_6ubogb0f6c48e02\" rows=\"5\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Description of near-miss is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<div id=\"frm_field_22_container\" class=\"frm_form_field form-field  frm_required_field frm_top_container\">\r\n    <label for=\"field_dy0ej0c43b08072\" id=\"field_dy0ej0c43b08072_label\" class=\"frm_primary_label\">Recommendations to prevent re-occurrence:\r\n        <span class=\"frm_required\">*<\/span>\r\n    <\/label>\r\n    <textarea name=\"item_meta[22]\" id=\"field_dy0ej0c43b08072\" rows=\"5\"  data-reqmsg=\"This field cannot be blank.\" aria-required=\"true\" data-invmsg=\"Recommendations to prevent re-occurrence: is invalid\" aria-invalid=\"false\"  ><\/textarea>\r\n    \r\n    \r\n<\/div>\n<input type=\"hidden\" id=\"field_pzo339ec3fbde3c\" name=\"item_meta[23]\" value=\"nearmiss@dutil.com\"  data-frmval=\"nearmiss@dutil.com\" data-invmsg=\"Hidden Field is invalid\"  \/>\t<input type=\"hidden\" name=\"item_key\" value=\"\" \/>\n\t\t\t\t<div class=\"frm_verify\" aria-hidden=\"true\">\n\t\t\t\t<label for=\"frm_email_3\">\n\t\t\t\t\tIf you are human, leave this field blank.\t\t\t\t<\/label>\n\t\t\t\t<input type=\"text\" class=\"frm_verify\" id=\"frm_email_3\" name=\"frm_verify\" value=\"\"  \/>\n\t\t\t<\/div>\n\t\t<div class=\"frm_submit\">\r\n\r\n<button class=\"frm_button_submit\" type=\"submit\"  >Submit<\/button>\r\n\r\n<\/div><\/div>\n<\/fieldset>\n<\/div>\n<\/form>\n<\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":32,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":[],"_links":{"self":[{"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=\/wp\/v2\/pages\/52"}],"collection":[{"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=52"}],"version-history":[{"count":3,"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=\/wp\/v2\/pages\/52\/revisions"}],"predecessor-version":[{"id":58,"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=\/wp\/v2\/pages\/52\/revisions\/58"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=\/wp\/v2\/media\/32"}],"wp:attachment":[{"href":"https:\/\/nearmiss.dutil.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=52"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}