{"id":44439,"date":"2021-01-18T07:20:59","date_gmt":"2021-01-18T12:20:59","guid":{"rendered":"http:\/\/ifdresourc.es\/forms\/?page_id=44439"},"modified":"2021-01-18T07:21:00","modified_gmt":"2021-01-18T12:21:00","slug":"ifd-safety-division-department-vehicle-accident","status":"publish","type":"page","link":"https:\/\/ifdresourc.es\/forms\/hs\/ifd-safety-division-department-vehicle-accident\/","title":{"rendered":"IFD Safety Division &#8211; Department Vehicle Accident"},"content":{"rendered":"<script type=\"text\/javascript\">if(!gform){document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0});var gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),null==t&&(t=10),gform.hooks[o][n].push({tag:i,callable:r,priority:t})},doHook:function(o,n,r){if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[o][n]){var t,i=gform.hooks[o][n];i.sort(function(o,n){return o.priority-n.priority});for(var e=0;e<i.length;e++)\"function\"!=typeof(t=i[e].callable)&#038;&#038;(t=window[t]),\"action\"==o?t.apply(null,r):r[0]=t.apply(null,r)}if(\"filter\"==o)return r[0]},removeHook:function(o,n,r,t){if(null!=gform.hooks[o][n])for(var i=gform.hooks[o][n],e=i.length-1;0<=e;e--)null!=t&#038;&#038;t!=i[e].tag||null!=r&#038;&#038;r!=i[e].priority||i.splice(e,1)}}}<\/script>\n                <div class='gf_browser_gecko gform_wrapper gf_stylespro_wrapper sp_inherit_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_45' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">IFD Safety Division - Department Vehicle Accident<\/h3>\n                            <span class='gform_description'><\/span>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_45' class='gf_stylespro sp_inherit gform_legacy_markup' action='\/forms\/wp-json\/wp\/v2\/pages\/44439' >\n                        <div class='gform_body gform-body'><ul id='gform_fields_45' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_45_1\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Incident Information<\/h2><\/li><li id=\"field_45_2\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\"><label class='gfield_label' for='input_45_2' >Date of Incident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_2' id='input_45_2' type='text' value='' class='datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_45_2_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_45_2_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_45_2' class='gform_hidden' value='https:\/\/ifdresourc.es\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_45_3\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\"><label class='gfield_label' for='input_45_3' >Day of the Week<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_45_3' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Sunday' >Sunday<\/option><option value='Monday' >Monday<\/option><option value='Tuesday' >Tuesday<\/option><option value='Wednesday' >Wednesday<\/option><option value='Thursday' >Thursday<\/option><option value='Friday' >Friday<\/option><option value='Saturday' >Saturday<\/option><\/select><\/div><\/li><li id=\"field_45_4\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_third o_medium\"  data-field-class=\"gf_third o_medium\"><label class='gfield_label gfield_label_before_complex'  >Time of Accident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class=\"ginput_complex\"><div class=\"clear-multi\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time' id='input_45_4'>\n                            <input type='text' maxlength='2' name='input_4[]' id='input_45_4_1' value=''    placeholder='HH' aria-required='true'   \/> <i>:<\/i>\n                            <label class='hour_label screen-reader-text' for='input_45_4_1' >Hours<\/label>\n                        <\/div>\n                        \n                        <div class='gfield_time_minute ginput_container ginput_container_time'>\n                            <input type='text' maxlength='2' name='input_4[]' id='input_45_4_2' value=''    placeholder='MM' aria-required='true'  \/>\n                            <label class='minute_label screen-reader-text' for='input_45_4_2' >Minutes<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below' >\n                                \n                                <select name='input_4[]' id='input_45_4_3'   aria-label='AM\/PM'>\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select> \n                           <\/div>\n                    <\/div><\/div><\/li><li id=\"field_45_5\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_5' >Apparatus \/ Vehicle<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_45_5' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Engine' >Engine<\/option><option value='Ladder' >Ladder<\/option><option value='Squad' >Squad<\/option><option value='Tac' >Tac<\/option><option value='Tanker' >Tanker<\/option><option value='TSU' >TSU<\/option><option value='Grass Rig' >Grass Rig<\/option><option value='Safety Car' >Safety Car<\/option><option value='EDO Car' >EDO Car<\/option><option value='Boat' >Boat<\/option><option value='Staff Car' >Staff Car<\/option><option value='MIRV' >MIRV<\/option><option value='Battalion Chief' >Battalion Chief<\/option><option value='Car' >Car<\/option><\/select><\/div><\/li><li id=\"field_45_6\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_6' >Apparatus \/ Car Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_45_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_7\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label'  >Reserve<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_45_7'>\n\t\t\t<li class='gchoice gchoice_45_7_0'>\n\t\t\t\t<input name='input_7' type='radio' value='Yes'  id='choice_45_7_0'    \/>\n\t\t\t\t<label for='choice_45_7_0' id='label_45_7_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_7_1'>\n\t\t\t\t<input name='input_7' type='radio' value='No'  id='choice_45_7_1'    \/>\n\t\t\t\t<label for='choice_45_7_1' id='label_45_7_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_8\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_8' >Asset Tag<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_45_8' type='text' value='' class='medium'  aria-describedby=\"gfield_description_45_8\"   aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_45_8'>Asset Tag should be located on the drivers door of any large apparatus. On BC buggies and staff cars it should be on the windshield and inside the drivers door. Along with the gas card pouch.<\/div><\/li><li id=\"field_45_9\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_9' >Apparatus Damage Estimate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_9' id='input_45_9' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_45_10\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_10' >Shift<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_45_10' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='A Shift' >A Shift<\/option><option value='B Shift' >B Shift<\/option><option value='C Shift' >C Shift<\/option><option value='Week Days' >Week Days<\/option><\/select><\/div><\/li><li id=\"field_45_11\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_11' >IFD Incident Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_45_11' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_12\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Location of Accident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address' id='input_45_12' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_45_12_1_container' >\n                                        <input type='text' name='input_12.1' id='input_45_12_1' value=''    aria-required='true'    \/>\n                                        <label for='input_45_12_1' id='input_45_12_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_45_12_2_container' >\n                                        <input type='text' name='input_12.2' id='input_45_12_2' value=''     aria-required='false'   \/>\n                                        <label for='input_45_12_2' id='input_45_12_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_45_12_3_container' >\n                                    <input type='text' name='input_12.3' id='input_45_12_3' value=''    aria-required='true'    \/>\n                                    <label for='input_45_12_3' id='input_45_12_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_45_12_4_container' >\n                                        <select name='input_12.4' id='input_45_12_4'     aria-required='true'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_45_12_4' id='input_45_12_4_label' >State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_45_12_5_container' >\n                                    <input type='text' name='input_12.5' id='input_45_12_5' value=''    aria-required='true'    \/>\n                                    <label for='input_45_12_5' id='input_45_12_5_label' >ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_12.6' id='input_45_12_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_45_13\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_list_2col o_medium\"  data-field-class=\"gf_list_2col o_medium\"><label class='gfield_label'  >Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_45_13'>\n\t\t\t<li class='gchoice gchoice_45_13_0'>\n\t\t\t\t<input name='input_13' type='radio' value='Emergency Response'  id='choice_45_13_0'    \/>\n\t\t\t\t<label for='choice_45_13_0' id='label_45_13_0'>Emergency Response<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_13_1'>\n\t\t\t\t<input name='input_13' type='radio' value='Returning from Response'  id='choice_45_13_1'    \/>\n\t\t\t\t<label for='choice_45_13_1' id='label_45_13_1'>Returning from Response<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_13_2'>\n\t\t\t\t<input name='input_13' type='radio' value='Parked on Scene'  id='choice_45_13_2'    \/>\n\t\t\t\t<label for='choice_45_13_2' id='label_45_13_2'>Parked on Scene<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_13_3'>\n\t\t\t\t<input name='input_13' type='radio' value='Parked Other'  id='choice_45_13_3'    \/>\n\t\t\t\t<label for='choice_45_13_3' id='label_45_13_3'>Parked Other<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_13_4'>\n\t\t\t\t<input name='input_13' type='radio' value='Non-Emergency Response'  id='choice_45_13_4'    \/>\n\t\t\t\t<label for='choice_45_13_4' id='label_45_13_4'>Non-Emergency Response<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_13_5'>\n\t\t\t\t<input name='input_13' type='radio' value='Not on Response (ie: store, fuel, etc.)'  id='choice_45_13_5'    \/>\n\t\t\t\t<label for='choice_45_13_5' id='label_45_13_5'>Not on Response (ie: store, fuel, etc.)<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_13_6'>\n\t\t\t\t<input name='input_13' type='radio' value='Parked on Station'  id='choice_45_13_6'    \/>\n\t\t\t\t<label for='choice_45_13_6' id='label_45_13_6'>Parked on Station<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_14\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_14' >Other<\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_45_14' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_15\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Emergency Devices in Use<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_45_15'><li class='gchoice gchoice_45_15_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.1' type='checkbox'  value='Lights'  id='choice_45_15_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_15_1' id='label_45_15_1'>Lights<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_15_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.2' type='checkbox'  value='Siren'  id='choice_45_15_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_15_2' id='label_45_15_2'>Siren<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_15_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_15.3' type='checkbox'  value='None'  id='choice_45_15_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_15_3' id='label_45_15_3'>None<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_77\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_77' >Law Enforcement CAD #<\/label><div class='ginput_container ginput_container_text'><input name='input_77' id='input_45_77' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_78\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label'  >Did Law Enforcement investigate?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_45_78'>\n\t\t\t<li class='gchoice gchoice_45_78_0'>\n\t\t\t\t<input name='input_78' type='radio' value='Yes'  id='choice_45_78_0'    \/>\n\t\t\t\t<label for='choice_45_78_0' id='label_45_78_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_78_1'>\n\t\t\t\t<input name='input_78' type='radio' value='No'  id='choice_45_78_1'    \/>\n\t\t\t\t<label for='choice_45_78_1' id='label_45_78_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_16\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_16' >Law Enforcement Investigator Name<\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_45_16' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_17\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_17' >Law Enforcement ID<\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_45_17' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_18\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Vehicle Operator Information<\/h2><\/li><li id=\"field_45_19\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_19' >Operator Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_45_19' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_20\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_20' >Operator Rank<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_45_20' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Private' >Private<\/option><option value='Engineer' >Engineer<\/option><option value='Lieutenant' >Lieutenant<\/option><option value='Captain' >Captain<\/option><option value='Battalion Chief' >Battalion Chief<\/option><option value='Civilian' >Civilian<\/option><\/select><\/div><\/li><li id=\"field_45_21\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_21' >Operator Date of Birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_21' id='input_45_21' type='text' value='' class='datepicker mdy datepicker_with_icon gdatepicker_with_icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_45_21_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_45_21_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_45_21' class='gform_hidden' value='https:\/\/ifdresourc.es\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_45_22\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_22' >Operator Gender<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_22' id='input_45_22' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/li><li id=\"field_45_23\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_23' >Driver&#039;s License Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_23' id='input_45_23' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_24\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_24' >Operator Battalion<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_24' id='input_45_24' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='Admin' >Admin<\/option><\/select><\/div><\/li><li id=\"field_45_25\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_25' >Operator Assigned Location<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_25' id='input_45_25' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Admin - HQ' >Admin - HQ<\/option><option value='Admin - Shops' >Admin - Shops<\/option><option value='Admin - Quartermaster' >Admin - Quartermaster<\/option><option value='Admin - Fire Prevention' >Admin - Fire Prevention<\/option><option value='Admin - Arson' >Admin - Arson<\/option><option value='Station 01' >Station 01<\/option><option value='Station 02' >Station 02<\/option><option value='Station 03' >Station 03<\/option><option value='Station 04' >Station 04<\/option><option value='Station 05' >Station 05<\/option><option value='Station 06' >Station 06<\/option><option value='Station 07' >Station 07<\/option><option value='Station 08' >Station 08<\/option><option value='Station 09' >Station 09<\/option><option value='Station 10' >Station 10<\/option><option value='Station 11' >Station 11<\/option><option value='Station 12' >Station 12<\/option><option value='Station 13' >Station 13<\/option><option value='Station 14' >Station 14<\/option><option value='Station 15' >Station 15<\/option><option value='Station 16' >Station 16<\/option><option value='Station 17' >Station 17<\/option><option value='Station 18' >Station 18<\/option><option value='Station 19' >Station 19<\/option><option value='Station 20' >Station 20<\/option><option value='Station 21' >Station 21<\/option><option value='Station 22' >Station 22<\/option><option value='Station 23' >Station 23<\/option><option value='Station 24' >Station 24<\/option><option value='Station 25' >Station 25<\/option><option value='Station 26' >Station 26<\/option><option value='Station 27' >Station 27<\/option><option value='Station 28' >Station 28<\/option><option value='Station 29' >Station 29<\/option><option value='Station 30' >Station 30<\/option><option value='Station 31' >Station 31<\/option><option value='Station 32' >Station 32<\/option><option value='Station 33' >Station 33<\/option><option value='Station 34' >Station 34<\/option><option value='Station 35' >Station 35<\/option><option value='Station 36' >Station 36<\/option><option value='Station 41' >Station 41<\/option><option value='Station 42' >Station 42<\/option><option value='Station 43' >Station 43<\/option><option value='Station 44' >Station 44<\/option><option value='Station 45' >Station 45<\/option><option value='Station 46' >Station 46<\/option><option value='Station 52' >Station 52<\/option><option value='Station 53' >Station 53<\/option><option value='Station 54' >Station 54<\/option><option value='Station 55' >Station 55<\/option><\/select><\/div><\/li><li id=\"field_45_26\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_hidden gf_list_2col o_medium\"  data-field-class=\"gf_list_2col o_medium\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label gfield_label_before_complex'  >Operator Work Assignment<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_45_26'><li class='gchoice gchoice_45_26_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.1' type='checkbox'  value='Regular Assignment'  id='choice_45_26_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_26_1' id='label_45_26_1'>Regular Assignment<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_26_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.2' type='checkbox'  value='Substitute'  id='choice_45_26_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_26_2' id='label_45_26_2'>Substitute<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_26_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.3' type='checkbox'  value='Roving \/  Unassigned'  id='choice_45_26_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_26_3' id='label_45_26_3'>Roving \/  Unassigned<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_26_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_26.4' type='checkbox'  value='Other'  id='choice_45_26_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_26_4' id='label_45_26_4'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_75\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gfsp_dot o_medium\"  data-field-class=\"gfsp_dot o_medium\"><label class='gfield_label'  >Operator Work Assignment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_45_75'>\n\t\t\t<li class='gchoice gchoice_45_75_0'>\n\t\t\t\t<input name='input_75' type='radio' value='Regular Assignment'  id='choice_45_75_0'    \/>\n\t\t\t\t<label for='choice_45_75_0' id='label_45_75_0'>Regular Assignment<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_75_1'>\n\t\t\t\t<input name='input_75' type='radio' value='Substitute'  id='choice_45_75_1'    \/>\n\t\t\t\t<label for='choice_45_75_1' id='label_45_75_1'>Substitute<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_75_2'>\n\t\t\t\t<input name='input_75' type='radio' value='Roving\/Unassigned'  id='choice_45_75_2'    \/>\n\t\t\t\t<label for='choice_45_75_2' id='label_45_75_2'>Roving\/Unassigned<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_75_3'>\n\t\t\t\t<input name='input_75' type='radio' value='Rideout'  id='choice_45_75_3'    \/>\n\t\t\t\t<label for='choice_45_75_3' id='label_45_75_3'>Rideout<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_75_4'>\n\t\t\t\t<input name='input_75' type='radio' value='Other'  id='choice_45_75_4'    \/>\n\t\t\t\t<label for='choice_45_75_4' id='label_45_75_4'>Other<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_76\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible gfsp_dot o_medium\"  data-field-class=\"gfsp_dot o_medium\"><label class='gfield_label'  >Work Status<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_45_76'>\n\t\t\t<li class='gchoice gchoice_45_76_0'>\n\t\t\t\t<input name='input_76' type='radio' value='Regular Shift'  id='choice_45_76_0'    \/>\n\t\t\t\t<label for='choice_45_76_0' id='label_45_76_0'>Regular Shift<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_76_1'>\n\t\t\t\t<input name='input_76' type='radio' value='Overtime'  id='choice_45_76_1'    \/>\n\t\t\t\t<label for='choice_45_76_1' id='label_45_76_1'>Overtime<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_76_2'>\n\t\t\t\t<input name='input_76' type='radio' value='Trade Time'  id='choice_45_76_2'    \/>\n\t\t\t\t<label for='choice_45_76_2' id='label_45_76_2'>Trade Time<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_76_3'>\n\t\t\t\t<input name='input_76' type='radio' value='Other'  id='choice_45_76_3'    \/>\n\t\t\t\t<label for='choice_45_76_3' id='label_45_76_3'>Other<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_27\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_27' >Operator Narrative<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_27' id='input_45_27' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_45_96\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_96' >If Operator is a certified Engineer, how long have they held the Engineer Certification?<\/label><div class='ginput_container ginput_container_text'><input name='input_96' id='input_45_96' type='text' value='' class='large'  aria-describedby=\"gfield_description_45_96\"    aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_45_96'>If not an Engineer, type NA.<\/div><\/li><li id=\"field_45_97\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_97' >If operator is a Certified Engineer, what is their primary apparatus?<\/label><div class='ginput_container ginput_container_select'><select name='input_97' id='input_45_97' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select One<\/option><option value='Engine' >Engine<\/option><option value='Ladder' >Ladder<\/option><option value='Squad' >Squad<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_45_98\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_98' >How many years of experience does the operator have driving an apparatus?<\/label><div class='ginput_container ginput_container_text'><input name='input_98' id='input_45_98' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_28\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Property Damage<\/h2><\/li><li id=\"field_45_29\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Damage Done to Property<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_45_29'><li class='gchoice gchoice_45_29_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.1' type='checkbox'  value='Motor Vehicle'  id='choice_45_29_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_29_1' id='label_45_29_1'>Motor Vehicle<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_29_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.2' type='checkbox'  value='Structure'  id='choice_45_29_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_29_2' id='label_45_29_2'>Structure<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_29_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.3' type='checkbox'  value='Overhead Door'  id='choice_45_29_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_29_3' id='label_45_29_3'>Overhead Door<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_29_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.4' type='checkbox'  value='None'  id='choice_45_29_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_29_4' id='label_45_29_4'>None<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_29_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_29.5' type='checkbox'  value='Other'  id='choice_45_29_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_29_5' id='label_45_29_5'>Other<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_30\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_30' >Other<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_45_30' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_31\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_31' >Business (if applicable)<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_45_31' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_70\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_70' >Owner \/ Driver Name<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_45_70' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_32\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_32' >Owner \/ Driver Date of Birth<\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_32' id='input_45_32' type='text' value='' class='datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='mm\/dd\/yyyy' aria-describedby=\"input_45_32_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_45_32_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_45_32' class='gform_hidden' value='https:\/\/ifdresourc.es\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_45_33\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_33' >Owner \/ Driver Gender<\/label><div class='ginput_container ginput_container_select'><select name='input_33' id='input_45_33' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Male' >Male<\/option><option value='Female' >Female<\/option><\/select><\/div><\/li><li id=\"field_45_35\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Owner \/ Driver Address<\/label>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_state has_zip ginput_container_address' id='input_45_35' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1' id='input_45_35_1_container' >\n                                        <input type='text' name='input_35.1' id='input_45_35_1' value=''    aria-required='false'    \/>\n                                        <label for='input_45_35_1' id='input_45_35_1_label' >Street Address<\/label>\n                                    <\/span><span class='ginput_full address_line_2 ginput_address_line_2' id='input_45_35_2_container' >\n                                        <input type='text' name='input_35.2' id='input_45_35_2' value=''     aria-required='false'   \/>\n                                        <label for='input_45_35_2' id='input_45_35_2_label' >Address Line 2<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city' id='input_45_35_3_container' >\n                                    <input type='text' name='input_35.3' id='input_45_35_3' value=''    aria-required='false'    \/>\n                                    <label for='input_45_35_3' id='input_45_35_3_label' >City<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state' id='input_45_35_4_container' >\n                                        <select name='input_35.4' id='input_45_35_4'     aria-required='false'    ><option value='' ><\/option><option value='Alabama' >Alabama<\/option><option value='Alaska' >Alaska<\/option><option value='Arizona' >Arizona<\/option><option value='Arkansas' >Arkansas<\/option><option value='California' >California<\/option><option value='Colorado' >Colorado<\/option><option value='Connecticut' >Connecticut<\/option><option value='Delaware' >Delaware<\/option><option value='District of Columbia' >District of Columbia<\/option><option value='Florida' >Florida<\/option><option value='Georgia' >Georgia<\/option><option value='Hawaii' >Hawaii<\/option><option value='Idaho' >Idaho<\/option><option value='Illinois' >Illinois<\/option><option value='Indiana' selected='selected'>Indiana<\/option><option value='Iowa' >Iowa<\/option><option value='Kansas' >Kansas<\/option><option value='Kentucky' >Kentucky<\/option><option value='Louisiana' >Louisiana<\/option><option value='Maine' >Maine<\/option><option value='Maryland' >Maryland<\/option><option value='Massachusetts' >Massachusetts<\/option><option value='Michigan' >Michigan<\/option><option value='Minnesota' >Minnesota<\/option><option value='Mississippi' >Mississippi<\/option><option value='Missouri' >Missouri<\/option><option value='Montana' >Montana<\/option><option value='Nebraska' >Nebraska<\/option><option value='Nevada' >Nevada<\/option><option value='New Hampshire' >New Hampshire<\/option><option value='New Jersey' >New Jersey<\/option><option value='New Mexico' >New Mexico<\/option><option value='New York' >New York<\/option><option value='North Carolina' >North Carolina<\/option><option value='North Dakota' >North Dakota<\/option><option value='Ohio' >Ohio<\/option><option value='Oklahoma' >Oklahoma<\/option><option value='Oregon' >Oregon<\/option><option value='Pennsylvania' >Pennsylvania<\/option><option value='Rhode Island' >Rhode Island<\/option><option value='South Carolina' >South Carolina<\/option><option value='South Dakota' >South Dakota<\/option><option value='Tennessee' >Tennessee<\/option><option value='Texas' >Texas<\/option><option value='Utah' >Utah<\/option><option value='Vermont' >Vermont<\/option><option value='Virginia' >Virginia<\/option><option value='Washington' >Washington<\/option><option value='West Virginia' >West Virginia<\/option><option value='Wisconsin' >Wisconsin<\/option><option value='Wyoming' >Wyoming<\/option><option value='Armed Forces Americas' >Armed Forces Americas<\/option><option value='Armed Forces Europe' >Armed Forces Europe<\/option><option value='Armed Forces Pacific' >Armed Forces Pacific<\/option><\/select>\n                                        <label for='input_45_35_4' id='input_45_35_4_label' >State<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip' id='input_45_35_5_container' >\n                                    <input type='text' name='input_35.5' id='input_45_35_5' value=''    aria-required='false'    \/>\n                                    <label for='input_45_35_5' id='input_45_35_5_label' >ZIP Code<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_35.6' id='input_45_35_6' value='United States' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/li><li id=\"field_45_36\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_36' >Owner \/ Driver Phone<\/label><div class='ginput_container ginput_container_phone'><input name='input_36' id='input_45_36' type='text' value='' class='medium'    aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_45_37\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_37' >Owner \/ Driver Driver&#039;s License Number<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_45_37' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_38\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_38' >Owner \/ Driver Insurance Company<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_45_38' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_39\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible gf_quarter o_medium\"  data-field-class=\"gf_quarter o_medium\"><label class='gfield_label' for='input_45_39' >Owner \/ Driver Policy Number<\/label><div class='ginput_container ginput_container_number'><input name='input_39' id='input_45_39' type='text'    value='' class='medium'      aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_45_71\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_71' >Property Damage Estimate<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_71' id='input_45_71' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_45_40\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_40' >Additional Information<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_40' id='input_45_40' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_45_41\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Injury Information<\/h2><\/li><li id=\"field_45_42\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_42' >Do you have an additional injury to report in from this same incident?<\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_45_42' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_45_43\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Injuries<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_45_43'><li class='gchoice gchoice_45_43_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.1' type='checkbox'  value='Apparatus Operator'  id='choice_45_43_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_43_1' id='label_45_43_1'>Apparatus Operator<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_43_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.2' type='checkbox'  value='Other Driver'  id='choice_45_43_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_43_2' id='label_45_43_2'>Other Driver<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_43_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.3' type='checkbox'  value='Property Owner \/ Occupant'  id='choice_45_43_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_43_3' id='label_45_43_3'>Property Owner \/ Occupant<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_43_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.4' type='checkbox'  value='Apparatus Passenger'  id='choice_45_43_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_43_4' id='label_45_43_4'>Apparatus Passenger<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_43_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_43.5' type='checkbox'  value='Other Passenger'  id='choice_45_43_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_43_5' id='label_45_43_5'>Other Passenger<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_44\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Supervisor Information<\/h2><\/li><li id=\"field_45_45\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_45' >Supervisor Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_45' id='input_45_45' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_46\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_46' >Supervisor Rank<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_46' id='input_45_46' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Private' >Private<\/option><option value='Lieutenant' >Lieutenant<\/option><option value='Captain' >Captain<\/option><option value='Battalion Chief' >Battalion Chief<\/option><option value='Chief' >Chief<\/option><\/select><\/div><\/li><li id=\"field_45_47\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label'  >Supervisor at Scene?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_45_47'>\n\t\t\t<li class='gchoice gchoice_45_47_0'>\n\t\t\t\t<input name='input_47' type='radio' value='Yes'  id='choice_45_47_0'    \/>\n\t\t\t\t<label for='choice_45_47_0' id='label_45_47_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_45_47_1'>\n\t\t\t\t<input name='input_47' type='radio' value='No'  id='choice_45_47_1'    \/>\n\t\t\t\t<label for='choice_45_47_1' id='label_45_47_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_48\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_48' >Supervisor Narrative<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_48' id='input_45_48' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_45_49\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Witness Information<\/h2><div class='gsection_description' id='gfield_description_45_49'>Include other crew members or witnesses<\/div><\/li><li id=\"field_45_72\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_72' >Number of Witnesses<\/label><div class='ginput_container ginput_container_select'><select name='input_72' id='input_45_72' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='0' >0<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><\/select><\/div><\/li><li id=\"field_45_50\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_50' >Witness #1 Name<\/label><div class='ginput_container ginput_container_text'><input name='input_50' id='input_45_50' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_51\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_51' >Witness #1 Rank\/Title<\/label><div class='ginput_container ginput_container_select'><select name='input_51' id='input_45_51' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Private' >Private<\/option><option value='Lieutenant' >Lieutenant<\/option><option value='Captain' >Captain<\/option><option value='Battalion Chief' >Battalion Chief<\/option><option value='Chief' >Chief<\/option><option value='Captain' >Captain<\/option><option value='Division Chief' >Division Chief<\/option><option value='Deputy Chief' >Deputy Chief<\/option><option value='Civilian' >Civilian<\/option><option value='Engineer' >Engineer<\/option><\/select><\/div><\/li><li id=\"field_45_52\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_52' >Witness #1 Narrative<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_52' id='input_45_52' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_45_53\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_53' >Witness #2 Name<\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_45_53' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_54\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_54' >Witness #2 Rank\/Title<\/label><div class='ginput_container ginput_container_select'><select name='input_54' id='input_45_54' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Private' >Private<\/option><option value='Lieutenant' >Lieutenant<\/option><option value='Captain' >Captain<\/option><option value='Battalion Chief' >Battalion Chief<\/option><option value='Chief' >Chief<\/option><option value='Division Chief' >Division Chief<\/option><option value='Deputy Chief' >Deputy Chief<\/option><option value='Captain' >Captain<\/option><option value='Civilian' >Civilian<\/option><\/select><\/div><\/li><li id=\"field_45_55\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_55' >Witness #2 Narrative<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_55' id='input_45_55' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_45_56\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_56' >Witness #3 Name<\/label><div class='ginput_container ginput_container_text'><input name='input_56' id='input_45_56' type='text' value='' class='medium'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_57\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_57' >Witness #3 Rank\/Title<\/label><div class='ginput_container ginput_container_select'><select name='input_57' id='input_45_57' class='medium gfield_select'     aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Private' >Private<\/option><option value='Lieutenant' >Lieutenant<\/option><option value='Captain' >Captain<\/option><option value='Battalion Chief' >Battalion Chief<\/option><option value='Chief' >Chief<\/option><option value='Division Chief' >Division Chief<\/option><option value='Deputy Chief' >Deputy Chief<\/option><option value='Captain' >Captain<\/option><option value='Civilian' >Civilian<\/option><\/select><\/div><\/li><li id=\"field_45_58\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_58' >Witness #3 Narrative<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_58' id='input_45_58' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_45_59\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Weather Data<\/h2><\/li><li id=\"field_45_73\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_73' >Temperature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_73' id='input_45_73' type='text'    value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_45_61\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Precipitation<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_45_61'><li class='gchoice gchoice_45_61_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.1' type='checkbox'  value='None'  id='choice_45_61_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_61_1' id='label_45_61_1'>None<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_61_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.2' type='checkbox'  value='Rain'  id='choice_45_61_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_61_2' id='label_45_61_2'>Rain<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_61_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.3' type='checkbox'  value='Fog'  id='choice_45_61_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_61_3' id='label_45_61_3'>Fog<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_61_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.4' type='checkbox'  value='Freezing Rain'  id='choice_45_61_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_61_4' id='label_45_61_4'>Freezing Rain<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_61_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.5' type='checkbox'  value='Drizzle'  id='choice_45_61_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_61_5' id='label_45_61_5'>Drizzle<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_61_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_61.6' type='checkbox'  value='Snow'  id='choice_45_61_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_61_6' id='label_45_61_6'>Snow<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_62\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label gfield_label_before_complex'  >Road Surface<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_45_62'><li class='gchoice gchoice_45_62_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.1' type='checkbox'  value='Dry'  id='choice_45_62_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_62_1' id='label_45_62_1'>Dry<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_62_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.2' type='checkbox'  value='Wet'  id='choice_45_62_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_62_2' id='label_45_62_2'>Wet<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_45_62_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_62.3' type='checkbox'  value='Icy'  id='choice_45_62_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_45_62_3' id='label_45_62_3'>Icy<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_45_63\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_63' >Visibility<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_63' id='input_45_63' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Sunrise' >Sunrise<\/option><option value='Daylight' >Daylight<\/option><option value='Sunset' >Sunset<\/option><option value='Dark' >Dark<\/option><\/select><\/div><\/li><li id=\"field_45_64\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Investigator Section<\/h2><\/li><li id=\"field_45_65\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_65' >Lead Investigator\/Safety Chief Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_65' id='input_45_65' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_89\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_89' >Lead Investigator Email Address<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_89' id='input_45_89' type='text' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_45_66\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_66' >Investigator Rank<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_66' id='input_45_66' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Captain' >Captain<\/option><option value='Battalion Chief' >Battalion Chief<\/option><option value='Chief' >Chief<\/option><option value='Division Chief' >Division Chief<\/option><option value='Deputy Chief' >Deputy Chief<\/option><\/select><\/div><\/li><li id=\"field_45_86\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_86' >Investigator\/Safety Chief Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_86' id='input_45_86' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='North' >North<\/option><option value='Central' >Central<\/option><option value='South' >South<\/option><option value='Other' >Other<\/option><\/select><\/div><\/li><li id=\"field_45_67\" class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_67' >Lead Investigator Narrative (Be extremely thorough with details)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_67' id='input_45_67' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_45_81\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_81' >Requesting Black Box Data<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_81' id='input_45_81' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_45_82\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_82' >Requesting Driver History Data<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_82' id='input_45_82' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_45_99\" class=\"gfield gfield--width-full gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_99' >Requesting Bay Door Maintenance History<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_45_99' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Select' >Select<\/option><option value='Yes' >Yes<\/option><option value='No' >No<\/option><\/select><\/div><\/li><li id=\"field_45_68\" class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\" ><h2 class=\"gsection_title\">Additional Information<\/h2><\/li><li id=\"field_45_90\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_90' >Name of Assigned Shift Commander on Date of Accident<\/label><div class='ginput_container ginput_container_text'><input name='input_90' id='input_45_90' type='text' value='' class='large'      aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_45_91\" class=\"gfield gfield--width-full field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='input_45_91' >Assigned Shift Commander&#039;s Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_91' id='input_45_91' type='text' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_45_69\" class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\" ><label class='gfield_label' for='gform_browse_button_45_69' >Case Paperwork<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_45_69' 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