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<!-- BEGIN outreach/questionnaire.tt -->
  [% questionnaire = outreach.questionnaire; # PROCESS dumper.tt dump = questionnaire %]
  
    <div class="indent">
      <h4 class="blue">Service assessment:</h4>
    
    <table class="xborders">
		<tr> 
			<td class="title" align="right" valign="top">Location preference:</td> 
			<td valign="top"> 
				<select name="location_preference"> 
					<option value="">--select one--</option> 
          [% FOREACH opt IN outreach.menu_options.location_preference %]
					<option value="[% opt %]"
              [% 'selected' IF questionnaire.location_preference == opt %]>
            [% opt %]
          </option>
          [% END %]          
				</select> 
			</td>
      
			<td colspan="2"> 
				<b>Monitoring quality opinion: </b>            
        <div>
          <textarea name="monitoring_comments" cols="40" rows="1"></textarea> 
        </div>        
      </td> 
		</tr> 
 
		<tr> 
			<td class="title" align="right" valign="top"> 
				<span class="acronym" title="default value: 999">
          Waiting duration</span>:		
			</td> 
			<td> 
				<input type="text" name="waiting_duration" size="5"
            value="[% questionnaire.waiting_duration %]" /> mins
			</td> 
			<td><b>Excessive</b>: 
					Yes<input type="radio" name="excessive_wait" 
            [% 'checked' IF questionnaire.excessive_wait == 'Y' %] value="Y" /> 
					No<input type="radio" name="excessive_wait"
            [% 'checked' IF questionnaire.excessive_wait == 'N' %] value="N" /> 
			</td> 
		</tr> 
    
    <tr> 
			<td class="title" valign="top" align="right">Transport difficulties: </td> 
			<td valign="top">
					Yes<input type="radio" name="transport_difficulty"
            [% 'checked' IF questionnaire.transport_difficulty == 'Y' %] value="Y" /> 
					No<input type="radio" name="transport_difficulty"
            [% 'checked' IF questionnaire.transport_difficulty == 'N' %] value="N" /> 
			</td> 
			<td class="title" valign="top">Transport difficulty details:
        <div>
          <textarea
          name="transport_difficulty_details" cols="40" rows="1"></textarea> 
        </div>        
      </td> 
		</tr> 
 
		<tr> 
			<td class="title">Transport arrangements:</td> 
			<td> 
				<select name="transport_arrangements"> 
					<option value="">--select one--</option> 
          [% FOREACH opt IN outreach.menu_options.transport_arrangements %]
					<option value="[% opt %]"
              [% 'selected' IF questionnaire.transport_arrangements == opt %]>
            [% opt %]
          </option>
          [% END %]          
				</select> 
			</td>
      [% INCLUDE outreach_submit %]
		</tr> 
	</table>
  </div>
<!-- BEGIN outreach/questionnaire.tt -->