templates/form.html

{% extends "base.html" %}

{% block title %}Form Keluhan{% endblock %}

{% block content %}
<div class="row">
  <div class="col-md-8 mx-auto">
    <div class="card">
      <div class="card-header"><h3 class="card-title">Form Tambah Keluhan</h3></div>
      <div class="card-body">
        <form action="#" method="post">
          
          <!-- Tanggal -->
          <div class="mb-3">
            <label class="form-label">Tanggal Keluhan</label>
            <input type="date" class="form-control" name="tanggal_keluhan" value="{{ current_date or '2025-06-05' }}">
          </div>

          <!-- Instansi -->
          <div class="mb-3">
            <label class="form-label">Instansi</label>
            <select class="form-select" name="instansi" required>
              <option selected disabled>Pilih instansi</option>
              {% for index, row in instansi.iterrows() %}
                <option value="{{ row['name'] }}">{{ row['name'] }}</option>
              {% endfor %}
            </select>
          </div>

          <!-- Kecamatan -->
          <div class="mb-3">
            <label class="form-label">Kecamatan</label>
            <select class="form-select" name="kecamatan" id="kecamatan" required>
              <option selected disabled>Pilih kecamatan</option>
              {% for index, row in kecamatan.iterrows() %}
                <option value="{{ row['name'] }}">{{ row['name'] }}</option>
              {% endfor %}
            </select>
          </div>

          <!-- Kelurahan -->
          <div class="mb-3">
            <label class="form-label">Kelurahan</label>
            <select class="form-select" name="kelurahan" id="kelurahan" required>
              <option selected disabled>Pilih kelurahan</option>
            </select>
          </div>

          <!-- Topik -->
          <div class="mb-3">
            <label class="form-label">Topik</label>
            <select class="form-select" name="topik" required>
              <option selected disabled>Pilih topik</option>
              {% for index, row in topik.iterrows() %}
                <option value="{{ row['name'] }}">{{ row['name'] }}</option>
              {% endfor %}
            </select>
          </div>

          <!-- Keluhan -->
          <div class="mb-3">
            <label class="form-label">Keluhan</label>
            <textarea class="form-control" name="keluhan" rows="3" placeholder="Masukkan keluhan Anda" required></textarea>
          </div>

          <button type="submit" class="btn btn-primary">Submit</button>
        </form>
      </div>
    </div>
  </div>
</div>

<!-- Kelurahan Map untuk JavaScript -->
<script>
  const kelurahanMap = {{ kelurahan_map | safe }};

  document.getElementById('kecamatan').addEventListener('change', function () {
    const kecamatan = this.value;
    const kelurahanSelect = document.getElementById('kelurahan');
    kelurahanSelect.innerHTML = '<option selected disabled>Pilih kelurahan</option>';

    if (kelurahanMap[kecamatan]) {
      kelurahanMap[kecamatan].forEach(function (kel) {
        const opt = document.createElement('option');
        opt.value = kel;
        opt.innerText = kel;
        kelurahanSelect.appendChild(opt);
      });
    }
  });
</script>
{% endblock %}