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www.histonimpington.municipal.report Open in urlscan Pro
2600:9000:21da:8000:16:3f5d:3600:93a1  Public Scan

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URL: https://www.histonimpington.municipal.report/
Submission: On March 06 via api from US — Scanned from US

Form analysis 1 forms found in the DOM

<form id="jiraForm">
  <header>
    <img src="/img/histon-impington-parish-council-logo.jpeg" alt="Histon and Impington Parish Logo">
  </header>
  <h2>Histon and Impington Parish - Create Issue</h2>
  <label for="category">Category<span style="color: red;">*</span>:</label>
  <select id="category">
    <option value="Please select a category">Please select a category</option>
    <option value="Test1">Test1</option>
    <option value="Test2">Test2</option>
    <option value="Test3">Test3</option>
    <option value="Test4">Test4</option>
  </select>
  <label for="subCategory" class="hidden">Sub-Category:</label>
  <select id="subCategory" name="subCategory" class="hidden" required="required"></select>
  <label for="categoryOther" class="hidden">Specify Other Category:</label>
  <input type="text" id="categoryOther" name="categoryOther" class="hidden">
  <label for="subject">Subject<span style="color: red;">*</span>:</label>
  <input type="text" id="subject" name="subject" required="">
  <label for="addressInput">Issue location<span style="color: red;">*</span>:</label>
  <input id="addressInput" type="text" placeholder="Enter Issue nearest address" required="" class="pac-target-input" autocomplete="off">
  <label for="description">Issue Description<span style="color: red;">*</span>:</label>
  <textarea id="description" name="description" rows="4" required=""></textarea>
  <label for="imageUpload">Upload Image:</label>
  <input type="file" id="imageUpload" name="imageUpload" accept="image/*;capture=camera">
  <hr class="style5">
  <label for="name">Your Name:</label>
  <input type="text" id="name" name="name">
  <label for="email">Your Email:</label>
  <input type="email" id="email" name="email" required="">
  <label for="phone">Your Phone Number:</label>
  <input type="tel" id="phone" name="phone" pattern="[0-9]{11}" placeholder="Format: 01234567890" required="">
  <div id="privacyCheckboxdiv" style="align-items: center; column-gap: 10px;">
    <input class="form-check-input" type="checkbox" id="privacyCheckbox" required="" style="flex: 0 0 auto; width: 20px;">
    <label class="form-check-label" for="privacyCheckbox" style="flex: 1; text-align: left;">
      <span style="color: red;">*</span> I have read and agree to the <a href="/Privacy.html" target="_blank">Privacy Policy</a>
    </label>
  </div>
  <div id="reCaptcha" class="g-recaptcha" data-sitekey="6Lf-pIgpAAAAAGiGSQ8QCRThWnmySA0Bj-dpW4Tz">
    <div style="width: 304px; height: 78px;">
      <div><iframe title="reCAPTCHA" width="304" height="78" role="presentation" name="a-asbu7bpj3tjk" frameborder="0" scrolling="no"
          sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox allow-storage-access-by-user-activation"
          src="https://www.google.com/recaptcha/api2/anchor?ar=1&amp;k=6Lf-pIgpAAAAAGiGSQ8QCRThWnmySA0Bj-dpW4Tz&amp;co=aHR0cHM6Ly93d3cuaGlzdG9uaW1waW5ndG9uLm11bmljaXBhbC5yZXBvcnQ6NDQz&amp;hl=en&amp;v=vj7hFxe2iNgbe-u95xTozOXW&amp;size=normal&amp;cb=uljw9ab9upzq"></iframe>
      </div><textarea id="g-recaptcha-response" name="g-recaptcha-response" class="g-recaptcha-response"
        style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
    </div><iframe style="display: none;"></iframe>
  </div>
  <div style="margin-top: 10px;">
    <button type="button" onclick="validateAndSubmit()">Create Issue</button>
  </div>
  <div id="ratingModal">
    <div class="modal-content">
      <span class="close" onclick="closeRatingModal()">×</span>
      <p>Please rate your experience:</p>
      <div class="rating">
        <span class="rating__result"></span>
        <i class="rating__star fas fa-star" onclick="rateExperience(1)"></i>
        <i class="rating__star fas fa-star" onclick="rateExperience(2)"></i>
        <i class="rating__star fas fa-star" onclick="rateExperience(3)"></i>
        <i class="rating__star fas fa-star" onclick="rateExperience(4)"></i>
        <i class="rating__star fas fa-star" onclick="rateExperience(5)"></i>
      </div>
      <label for="feedbackText">Optional Feedback:</label>
      <textarea id="feedbackText" name="feedbackText" rows="4" placeholder="Optional"></textarea>
      <button type="button" onclick="submitFeedback()">Submit Feedback</button>
      <button type="button" onclick="notNow()">Not Now</button>
    </div>
  </div>
  <div id="banner">
    <a href="https://www.municipal.report/" target="_blank" style="width: 60px;">
                <img src="/img/logo.png" alt="Re:Port" style="width: 100%; height: auto;">
            </a>
    <p style="color:white; font-size: x-small;">Powered by Re:Port</p>
  </div>
</form>

Text Content

HISTON AND IMPINGTON PARISH - CREATE ISSUE

Category*: Please select a categoryTest1Test2Test3Test4 Sub-Category: Specify
Other Category: Subject*: Issue location*: Issue Description*: Upload Image:

--------------------------------------------------------------------------------

Your Name: Your Email: Your Phone Number:
* I have read and agree to the Privacy Policy

Create Issue
×

Please rate your experience:


Optional Feedback: Submit Feedback Not Now

Powered by Re:Port