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pre-loss-form.html
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<!DOCTYPE html>
<html lang="en">
<head>
<meta charset="UTF-8">
<meta name="viewport" content="width=device-width, initial-scale=1.0">
<title>Inspection form</title>
<link rel="shortcut icon" href="Assets/leadwayLG.png" type="image/x-icon">
<link rel="stylesheet" href="styles/inspection-form.css">
<link rel="stylesheet" href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/5.15.4/css/all.min.css">
<link rel="preconnect" href="https://fonts.googleapis.com" />
<link rel="preconnect" href="https://fonts.gstatic.com" crossorigin/>
<link
href="https://fonts.googleapis.com/css2?family=Mulish:ital,wght@0,200..1000;1,200..1000&display=swap"
rel="stylesheet"
/>
<link
rel="stylesheet"
href="https://cdnjs.cloudflare.com/ajax/libs/font-awesome/4.7.0/css/font-awesome.min.css"
/>
</head>
<body>
<div class="container-fixed">
<div class="sidebar">
<div class="sidenav1">
<nav>
<ul>
<li><a href="./user.html"><img src="Assets/dashboard_1-removebg-preview.png"></a></li>
<li class="active"><a href="#"><img src="Assets/calender.svg"></a></li>
<li><a href="#"><img src="Assets/radio.svg"></a></li>
<li><a href="#"><img src="Assets/dashboard-2.svg"></a></li>
<li><a href="#"><img src="Assets/pie-svg.svg"></a></li>
<li><a href="#"><img src="Assets/setting-svg.svg"></a></li>
</ul>
</nav>
</div>
<div class="sidenav2">
<div class="logo">
<img src="Assets/LAC_Logo_Alt_2-removebg-preview.png" alt="Leadway Assurance">
</div>
<nav>
<ul>
<li><a href="#"></i>TRM</a></li>
<li><a href="overview.html"><img src="Assets/top-lines.svg"> Overview</a></li>
<li><a href="./requests.html"><img src="Assets/lines.svg"> Requests</a></li>
</ul>
</nav>
</div>
</div>
<div class="main-content">
<div class="top-nav">
<div class="top-nav-content">
<img src="Assets/notification-bell.svg" class="notification">
<img src="Assets/Group 38.svg" class="am">
<p>Gabriel <img src="Assets/dropdown.png" class="dropdown"></p>
</div>
</div>
<div class="header">
<div class="">
<h1> <b>Create New Inspection</b></h1>
<p>See inspections across all business classes</p>
</div>
<a href="./new-inspection.html"><button class="btn-new-inspection"><img src="Assets/back-arrow key.jpg"> Back to create request</button></a>
</div>
<form action="">
<h2>Pre Loss Link Generation(Optional)</h2>
<div class="info">
<div class="name-info">
<div>
<label for="name">
Policy Number(Optional)
</label>
<input type="text" placeholder="Your number">
</div>
<div>
<label for="name">
Claim Number(Optional)
</label>
<input type="text" placeholder="Your number">
</div>
</div>
<hr>
<div class="number-info">
<div>
<div>
<label for="name">
Client First Name
</label>
<input type="text" placeholder="Your First name">
</div>
<div>
<label for="name">
Client Phone Number
</label>
<input type="text" placeholder="+234 Your Phone Number">
</div>
</div>
<div>
<div>
<label for="name">
Client Last Name
</label>
<input type="text" placeholder="Your Last Name">
</div>
<div>
<label for="name">
Client Email
</label>
<input type="text" placeholder="Your Email">
</div>
</div>
</div>
<hr>
<div class="number-info">
<div>
<div>
<label for="name">
Vehicle Make
</label>
<input type="text" placeholder="Your Vehicle make">
</div>
<div>
<label for="name">
Vehicle Model
</label>
<input type="text" placeholder="Your Vehicle Model">
</div>
</div>
<div>
<div>
<label for="name">
Registration number
</label>
<input type="text" placeholder="Your Registration Number">
</div>
<div>
<label for="name">
Year
</label>
<input type="text" placeholder="Select ">
</div>
</div>
</div>
<p class="comment">Comments</p>
<textarea rows="10"></textarea>
<p class="attachment"> Attach document</p>
<button id="generate-inspection-btn"class="generate-inspection-btn"><a href="">Generate</a></button>
</div>
<div id="overlay" class="overlay">
<div class="popup">
<h1>Send TRM</h1>
<p>Are you sure you want to creat this request?</p>
<button id="confirmButton">submit</button>
<button id="cancelButton">cancel</button>
</div>
</div>
</div>
</form>
</div>
</div>
</div>
<script>
document.addEventListener("DOMContentLoaded", function() {
const generateBtn = document.getElementById("generate-inspection-btn");
const overlay = document.getElementById("overlay");
const confirmButton = document.getElementById("confirmButton");
const cancelButton = document.getElementById("cancelButton");
generateBtn.addEventListener("click", function(e) {
e.preventDefault();
overlay.style.display = "flex";
});
confirmButton.addEventListener("click", function(e) {
// Add your delete logic here
e.preventDefault();
window.location.href = "./success.html"
overlay.style.display = "none";
});
cancelButton.addEventListener("click", function(e) {
e.preventDefault();
overlay.style.display = "none";
});
});
</script>
</body>
</html>