If Then within Subroutine that uses Parameters


D

dancer

The following code works well. Upon Submit, It sends information to an
email address. It also sends the same information to a database.
If the user clicks "Submit" but has not changed the drop down selections
from "Choose One" to another of the items, it notifies in red and exits the
btnSendMail_onClick subroutine. --Just as I want.

There is only one problem:
Although it halts the SendMail subroutine, it sends the info to the database
via the subroutine btn_SendDatabase_OnClick, even if "Choose One" is
selected. If I try to put the same "If - then" code within the SendDatabase
subroutine that I have within the SendMail subroutine, which alerts the user
to choose, I get the error, " Name 'TheWhicheverVariableIsFirst' not
declared"

Who has the answer?
--------------------------------------------------------------------------------------------------
<%@ Page Language="VB" Debug = "true" ValidateRequest="false" %>
<%@ Import Namespace="System.Web.Mail" %>

<%@ Import Namespace="System.Data.Oledb" %>

<script language="VB" runat="server">

Sub SendMailandDatabase(Source As Object, E As EventArgs)


btnSendMail_OnClick

btnSendDatabase_OnClick

End Sub



Sub btnSendMail_OnClick

Dim TheEmpName As String = EmpName.text

Dim TheHomeNumber As String = HomeNumber.text

Dim TheDateofAccident As String = DateofAccident.Text

Dim TheNotifyDate As String = NotifyDate.Text

Dim TheTimeAM As String = am.Text

Dim TheTimePM As String = pm.Text

Dim TheTime As String

Dim Thedie As String = Die.SelectedItem.Text

Dim TheLostDays As String = LostDays.SelectedItem.Text

Dim TheStateOfInjury As String = StateOfInjury.Text

Dim TheStreet As String = street.text

Dim TheCity As String = city.text

Dim TheAddressState as String = AddressState.Text

Dim TheZip As String = Zip.text

Dim Thebirth as String = Birth.Text

Dim TheSSN As String = SSN.text

Dim TheSex As String = Sex.SelectedItem.Text

Dim TheMarital As String = Marital.SelectedItem.Text

Dim TheContactNumber As String = ContactNumber.Text

Dim TheJob As string = Job.SelectedItem.Text

Dim ThePart As String = Part.Text

Dim TheSupervisor As String = Supervisor.Text

Dim TheHours As String = Hours.Text

Dim TheDays As String = Days.Text

Dim TheNature As String = nature.SelectedItem.Text

'Dim TheNatureNew As String

Dim TheDescription As String = Description.Text

Dim TheCaused As String = Caused.Text

Dim TheInitial As String = Initial.SelectedItem.Text

Dim TheProvider As String = Provider.SelectedItem.Text

Dim TheAdmitted As String = Admitted.SelectedItem.Text

Dim TheProviderName as String = ProviderName.Text

Dim TheProviderStreet as string = ProviderStreet.Text

Dim TheProviderCity as string = ProviderCity.Text

Dim TheProviderPhone as string = ProviderPhone.Text

Dim Thefull as String = Full.Text

Dim TheFullNew As String

Dim TheOccur As String = Occur.SelectedItem.Text

Dim TheWhere As String = Where.Text

Dim TheAccidentStreet As String = AccidentStreet.Text

Dim TheAccidentCity As String = AccidentCity.Text

dim TheAccidentState as String = AccidentState.Text

Dim TheAccidentZip as String = AccidentZip.Text

Dim TheOtherClaims as String = OtherClaims.SelectedItem.Text

Dim TheSafetyDevices as string = SafetyDevices.selectedItem.Text

Dim TheDevicesUtilized as string = DevicesUtilized.selectedItem.Text

Dim TheWitness as string = Witness.SelectedItem.Text

Dim TheWitnessName as String = WitnessName.Text

Dim TheReceivePay as String = ReceivePay.SelectedItem.Text

Dim TheComments as String = Comments.Text

Dim TheCommentsNew as String

Dim ThePrevented as String = Prevented.Text

Dim ThePreventedNew as String

Dim TheSubmitter As String = Submitter.Text

Dim TheTitle As String = Title.Text

Dim TheToday As String = Today.Text

Dim TheLocation As String = Location.SelectedItem.Text

Dim myMessage As New MailMessage

Dim myMail As SmtpMail

Dim strEmail As String

Dim UserMessage As String


If TheTimeAm <> "" Then

TheTime = TheTimeAm & " AM"

ElseIf TheTimePM <> "" Then

TheTime = TheTimePM & " PM"

Else TheTime = ""

End If

If TheTime = "" then

Response.Write("<font color=""red"">ERROR: You must enter a time</font>")

Exit Sub

End If

If TheJob = "Choose One" Then

Response.Write("<font color=""red"">ERROR: You must Choose a Job
Description</font>")

Exit Sub

End If

If TheNature = "Choose One" Then

Response.Write("<font color=""red"">ERROR: You must Select the Nature of the
Injury</font>")

Exit Sub

End If

If TheLocation = "Choose One" Then

Response.Write("<font color=""red"">ERROR: You must Choose a Wheeler's
Division</font>")

Exit Sub

End If


TheCommentsNew = TheComments.Replace(vbCrLf,"<br />")

ThePreventedNew = ThePrevented.Replace(vbCrLf,"<br />")

TheFullNew = TheFull.Replace(vbCrLf,"<br />")

If Page.IsValid() Then


Response.Write ("<font color=""red"">FORM HAS BEEN SENT TO
RIVERSIDE</font>")


myMessage.From = "(e-mail address removed)"

MyMessage.To = "(e-mail address removed);"

myMessage.Subject = "Accident Form"

' This is the magic line. Without this the message will just appear

' as plain HTML and won't be rendered by the recipient's email client.

' It'd be as if they did "View Source" on a web page.

MyMessage.BodyFormat = MailFormat.Html



myMessage.Body = "<h2>Wheeler's Express Accident Report Form</h2>" & vbCrLf
_

& " <p>" & vbCrLf _

& "<html><body> <table width = ""750"" bgcolor=""#E9EDF4"" height=""25""
border=""1"" cellpadding=""1"" cellspacing=""0""fontface=""Verdana""
Size=""2"">" & vbCrLf _

& "<td colspan=""3"" bgcolor=""maroon"" align=""center""> <font
face=""Verdana"" Size=""2"" color=""white""><b> BASIC CLAIM
FACTS</b></td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2""> Employee's Name: <b> " &
TheEmpName & "</b></td>" & vbCrLf _

& "<td colspan=""2""> <font face=""Verdana"" Size=""2"">Home Phone Number:
<b>"& TheHomeNumber & "</b></td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2"">Date of Injury: <b>" &
TheDateOfAccident & "<br>" & "</b></td>" & vbCrLf _

& "<td> <font face=""Verdana"" Size=""2"">Time of Injury: <b>" & TheTime &
"<br>" & "</td></tr>" & "</b></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2"">Date Employer Notified:<b> " &
TheNotifyDate & "</b></td>" & vbCrLf _

& "<td> <font face=""Verdana"" Size=""2"">Did Employee Die?<b> " & Thedie &
"</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""1""> <font face=""Verdana"" Size=""2"">Has the Injured
Employee Lost Days From Work?<b> " & TheLostDays & "</b></td>" & vbCrLf _

& "<td colspan=""2""> <font face=""Verdana"" Size=""2"">What State Did
Injury Occur? <b> " & TheStateOfInjury & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3"" bgcolor=""maroon"" align=""center""> <font
face=""Verdana"" Size=""2"" color=""white""><b> EMPLOYER
INFORMATION</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""> <font face=""Verdana"" Size=""2"">Employer Name:
</td></tr>" & vbCrLf _

& "<tr><td height=""35"" valign=""bottom"" colspan=""3""><font
face=""Verdana"" Size=""2""> Work Location: <font face=""Verdana""
Size=""1"">
(street)&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp"
& vbCrLf _

&
"(city)&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp(state)&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp(Zip)</td></tr>"
& vbCrLf _

& "<tr><td colspan=""3""> <font face=""Verdana"" Size=""2"">Nature of
Business: </td></tr>" & vbCrLf _

& "<tr><td colspan=""3""> <font face=""Verdana"" Size=""2"">Employee FED ID:
</td></tr>" & vbCrLf _

& "<tr><td colspan=""3""> <font face=""Verdana"" Size=""2"">Liberty Mutual
Policy # &nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp" &
vbCrLf _

&
"&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp
Store# </td></tr>" & vbCrLf _

& "<tr><td colspan=""1""> <font face=""Verdana"" Size=""2"">Employer Code:
</td>" & vbCrLf _

& "<td colspan=""2""> <font face=""Verdana"" Size=""2"">Employer Location
Code: </td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2"">Employer SIC Code: </td>" &
vbCrLf _

& "<td> <font face=""Verdana"" Size=""2"">Employer Type: </td></tr>" &
vbCrLf _

& "<tr><td colspan=""3"" bgcolor=""maroon"" align=""center""> <font
face=""Verdana"" Size=""2"" color=""white""><b> INJURED EMPLOYEE
</b></td></tr>" & vbCrLf _

& "<tr><td colspan= ""3""><font face=""Verdana"" Size=""2""> Home Address:
<b>" & TheStreet & "&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp" & TheCity &
"&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp" & TheAddressState & "&nbsp&nbsp&nbsp" &
TheZip & "</b></td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2"">Date of Birth:<b>" & TheBirth
& "</b></td>" & vbCrLf _

& "<td> <font face=""Verdana"" Size=""2"">SSN:<b> " & TheSSN & "</b></td>" &
vbCrLf _

& "<td> <font face=""Verdana"" Size=""2""><b> " & TheSex & "</b></td></tr>"
& vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2"">Marital Status:<b> " &
TheMarital & "</b></td>" & vbCrLf _

& "<tr><td colspan = ""3""> <font face=""Verdana"" Size=""2"">Phone Number
where Employee can be contacted:<b> " & TheContactNumber & "</b></td></tr>"
& vbCrLf _

& "<tr><td><font face=""Verdana"" Size=""2"">Job Description:<b> " & TheJob
& "</b></td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2"">Supervisor's Name:<b> " &
TheSupervisor & "</b></td>" & vbCrLf _

& "<td> <font face=""Verdana"" Size=""2""> Hire Date: " & "</b></td></tr>" &
vbCrLf _

& "<td colspan=""2""> <font face=""Verdana"" Size=""2"">Work Per Week <b>" &
TheHours & "</b>&nbsp&nbsp Hours <b>" & TheDays & "</b>&nbsp&nbsp Days </b>
</td>" & vbCrLf _

& "<tr><td><font face=""Verdana"" Size=""2""></td></tr>" & vbCrLf _

& "<tr><td colspan=""3"" bgcolor=""maroon"" align=""center""> <font
face=""Verdana"" Size=""2"" color=""white""><b> INJURY OR ILLNESS
</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""> <font face=""Verdana"" Size=""2"">Which Part of
the Body Was Injured? <b> " & ThePart & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> What was the
Nature of Injury? <b>" & TheNature & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Injury/Illness
Description <b> " & TheDescription & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Initial Medical
Treatment: <b> " & TheInitial & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2"">What Type of
Medical Provider Performed Treatment? <b>" & TheProvider & "</b></td></tr>"
& vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Was Employee
Admittted into a Hospital? <b>" & TheAdmitted & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Medical Provider
Name: <b>" & TheProviderName & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Medical Provider
Address: <b>" & TheProviderStreet & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Medical Provider
City State: <b>" & TheProviderCity & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Medical Provider
Phone: <b>" & TheProviderPhone & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Give a Full
Description of the Accident: <b>" & TheFullNew & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> What Caused The
Injury? <b>" & TheCaused & "</b></td></tr>" & vbCrLf _

& "<tr><td><font face=""Verdana"" Size=""2""> Did the Accident Occur at the
Store or Plant? <b>" & TheOccur & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""2""> <font face=""Verdana"" Size=""2""> If No, where
did the accident occur?<b>" & TheWhere & "</b></td>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2""> Accident Address <b>" &
TheAccidentStreet & "</b></td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2""> Accident City <b>" &
TheAccidentCity & "&nbsp" & TheAccidentState & "&nbsp" & TheAccidentZip &
"</b></td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2""> Are Other Claims Involved?
<b>" & TheOtherClaims & "</b></td>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2""> Safety Devices Provided? <b>"
& TheSafetyDevices & "</b></td>" & vbCrLf _

& "<td> <font face=""Verdana"" Size=""2""> Safety Devices Utilized? <b>" &
TheDevicesUtilized & "</b></td></tr>" & vbCrLf _

& "<tr><td> <font face=""Verdana"" Size=""2""> Was There a Witness <b>" &
TheWitness & "</b></td>" & vbCrLf _

& "<td colspan=""2""> <font face=""Verdana"" Size=""2""> If yes, ListName
<b>" & TheWitnessName & "</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3"" bgcolor=""maroon"" align=""center""> <font
face=""Verdana"" Size=""2"" color=""white""><b> DISABILITY STATUS
</b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""> Did Employee
Receive Pay for Date of Injury? <b>" & TheReceivePay & "</b></td></tr>" &
vbCrLf _

& "<tr><td colspan=""3"" bgcolor=""maroon"" align=""center""> <font
face=""Verdana"" Size=""2"" color=""white""><b> ADDITIONAL COMMENTS &
INFORMATION </b></td></tr>" & vbCrLf _

& "<tr><td colspan=""3""><font face=""Verdana"" Size=""2""><b>" &
TheCommentsNew & " </b></td></tr>" & vbCrLf _

& "<tr> <td> <font face=""Verdana"" Size=""2"">Person submitting this form:
" & "<b>" & theSubmitter & "</b></td>" & vbCrLf _

& "<td> <font face=""Verdana"" Size=""2"">Title: " & "<b>" & theTitle &
"</b></td></tr>" & vbCrLf _

& "<td> <font face=""Verdana"" Size=""2"">Date: <b> " & Thetoday & "</b>" &
vbCrLf _

& "<td> <font face=""Verdana"" Size=""2"">Location: <b> " & TheLocation &
"</b>" & vbCrLf _

& "<tr> <td colspan=""3""> <font face=""Verdana"" Size=""2"">How can the
above incident be prevented from happening again? " & "<b>" &
ThePreventedNew & "</b></td>" & vbCrLf _

& "</td><tr></table> </body>"




' Doesn't have to be local... just enter your

' SMTP server's name or ip address!

'myMail.SmtpServer = "smtp.XXXXXX.com"

myMail.SmtpServer = ""

myMail.Send(myMessage)

frmEmail.Visible = False

UserMessage = "Has Been Sent."


End If

End Sub

'*************SEND TO
DATABASE***************************************************************************

Sub btnSendDatabase_OnClick

Dim strConn As String = ("Provider=Microsoft.Jet.Oledb.4.0;Data Source=" &
Server.Mappath("~\Acc.mdb") & ";")


Dim MySql AS String = "INSERT INTO
Table1(TheEmpName,TheDateOfAccident,TheNotifyDate,TheToday,TheBirth," &
vbcrlf _

& "TheSSN, TheJob, TheSupervisor, ThePart, TheHours, TheDays, TheNature," &
vbcrlf _

& "TheDescription, TheInitial, TheProvider, TheAdmitted, TheProviderName,
TheOccur," & vbcrlf _

&
"TheWhere,TheAccidentStreet,TheAccidentCity,TheAccidentState,TheAccidentZip,"
& vbcrlf _

& "TheOtherClaims, TheSafetyDevices, TheDevicesUtilized, TheWitness,
TheWitnessName," & vbcrlf _

& "ThePreventedNew, TheSubmitter, TheTitle, TheLocation)" & vbcrlf _

& "VALUES(@TheEmpName, @TheDateOfAccident, @TheNotifyDate,@TheToday,
@TheBirth," & vbcrlf _

& "@TheSSN, @TheJob, @TheSupervisor, @ThePart, @TheHours, @TheDays,
@TheNature," & vbcrlf _

& "@TheDescription, @TheInitial, @TheProvider, @TheAmitted,
@TheProviderName, @TheOccur," & vbcrlf _

& "@TheWhere,@TheAccidentStreet,@TheAccidentCity,@TheAccidentState,
@TheAccidentZip," & vbcrlf _

& "@TheOtherClaims, @TheSafetyDevices, @TheDevicesUtilized, @TheWitness,
@TheWitnessName," & vbcrlf _

& "@ThePreventedNew,@TheSubmitter, @TheTitle, @TheLocation)"


Dim MyConn as New OleDbConnection(strConn)

Dim Cmd as New OleDbCommand(MySQL, MyConn)


With Cmd.Parameters:

..Add(New OleDbParameter("@TheEmpName", EmpName.text))

..Add(New OleDbParameter("@TheDateOfAccident", DateOfAccident.Text))

..Add(New OleDbParameter("@TheNotifyDate", NotifyDate.Text))

..Add(New OleDbParameter("@TheToday", Today.Text))

..Add(New OleDbParameter("@TheBirth", Birth.Text))

..Add(New OleDbParameter("@TheSSN", SSN.Text))

..Add(New OleDbParameter("@TheJob", Job.SelectedItem.Text))

..Add(New OleDbParameter("@TheSupervisor", Supervisor.Text))

..Add(New OleDbParameter("@ThePart", Part.Text))

..Add(New OleDbParameter("@TheHours", Hours.Text))

..Add(New OleDbParameter("@TheDays", Days.Text))

..Add(New OleDbParameter("@TheNature", Nature.SelectedItem.Text))

..Add(New OleDbParameter("@TheDescription", Description.Text))

..Add(New OleDbParameter("@TheInitial", Initial.SelectedItem.Text))

..Add(New OleDbParameter("@TheProvider", Provider.SelectedItem.Text))

..Add(New OleDbParameter("@TheAdmitted", Admitted.SelectedItem.Text))

..Add(New OleDbParameter("@TheTheProviderName", ProviderName.Text))

..Add(New OleDbParameter("@TheOccur", Occur.SelectedItem.Text))

..Add(New OleDbParameter("@TheWhere", Where.Text))

..Add(New OleDbParameter("@TheAccidentStreet", AccidentStreet.Text))

..Add(New OleDbParameter("@TheAccidentCity", AccidentCity.Text))

..Add(New OleDbParameter("@TheAccidentState", AccidentState.Text))

..Add(New OleDbParameter("@TheAccidentZip", AccidentZip.Text))

..Add(New OleDbParameter("@TheOtherClaims", OtherClaims.SelectedItem.Text))

..Add(New OleDbParameter("@TheSafetyDevices",
SafetyDevices.SelectedItem.Text))

..Add(New OleDbParameter("@TheDevicesUtilized",
DevicesUtilized.SelectedItem.Text))

..Add(New OleDbParameter("@TheWitness", Witness.SelectedItem.Text))

..Add(New OleDbParameter("@TheWitnessName", WitnessName.Text))

..Add(New OleDbParameter("@ThePreventedNew", Prevented.Text))

..Add(New OleDbParameter("@TheSubmitter", Submitter.Text))

..Add(New OleDbParameter("@TheTitle", Title.Text))

..Add(New OleDbParameter("@TheLocation", Location.SelectedItem.Text))



end with

MyConn.Open()

cmd.ExecuteNonQuery()

MyConn.Close

End Sub

'**************************************************************************************************8


</script>

<html>

<head>

<title>ASP.NET Email (HTML Format) Sample</title>

</head>

<body>


<table width="750" bgcolor="#E9EDF4" table border="1" cellpadding="3">

<h3><center><font face="Verdana">Wheeler's Express Accident Report
Form</font></center></h3>



<form method="post" id="frmEmail" runat="server">




<%--____________________________________________________________________________--%>

<%--Section 1--%>

<tr><td colspan="3" bgcolor="maroon" align="center"> <font face="Verdana"
Size="2" color="white"><b> BASIC CLAIM FACTS</b></td></tr>


<td bgcolor="#E9EDF4" colspan="2">

<font face="Verdana" Size="2">

Employee's Name: <asp:textbox id="EmpName" runat=server columns="45"/>

<asp:RequiredFieldValidator id="RequiredFiedlValidator1" display=dynamic
runat="server" Text="The Employee name is required."

ControlToValidate="EmpName"></asp:RequiredFieldValidator>

</td>

<%---------------------------------------------------------------------------%>

<td align="right" valign="top">


<font face="Verdana" Size="2">Home Phone Number

<asp:TextBox id=HomeNumber runat="server"/>


</td></tr>

<%--____________________________________________________________________________--%>

<%--ROW 2--%>


<tr><td colspan="1" valign="center">

<font face="Verdana" Size="2">Date of Injury </font>

<asp:textbox id="DateofAccident" runat=server /></asp:textbox>

<asp:RequiredFieldValidator id="RequiredFieldValidator2" runat="server"

Text="The Date field is required" ControlToValidate="Dateofaccident">

</asp:RequiredFieldValidator>

</td><td colspan="2"><font face="Verdana" Size="2">Time of Injury
<asp:textbox columns="6" id ="am" runat=server/>a.m.

<asp:textbox columns="6" id= "pm" runat = server/> p.m.</td>

</TD>

</tr>



<tr>

<td>

<font face="Verdana" Size="2">Date Employer Notified <asp:textbox
id="Notifydate" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorNotify" runat="server"

Text="This field is required" ControlToValidate="NotifyDate">

</asp:RequiredFieldValidator>


</td>

<td colspan="2"> <font face="Verdana" Size="2"> Did employee die?
<asp:RadioButtonList id="Die" RepeatDirection="Horizontal" Runat=server>

<asp:ListItem><font face="Verdana" Size="2">Yes</asp:ListItem>

<asp:ListItem><font face="Verdana" Size="2">No</asp:ListItem>
</asp:RadioButtonList>

</td></tr>


<tr><td> <font face="Verdana" Size="2"> Has the Injured Employee Lost Days
From Work?

<asp:RadioButtonList id="LostDays" font-name="verdana" font-size="10 pt"
RepeatDirection="Horizontal" Runat=server>

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem> </asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorLostDays"
Display=Dynamic runat="server"

Text="This field is required" ControlToValidate="LostDays">

</asp:RequiredFieldValidator>




<td colspan="3"><font face="Verdana" Size="2">What State did Injury Occur?
<asp:textbox id="StateOfInjury" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorStateofInjury"
Display=Dynamic runat="server"

Text="The State is required" ControlToValidate="StateOfInjury">

</asp:RequiredFieldValidator>

</td></tr>

<%--SECTION3-----------------------------------------------------------------------------------%>

<tr><td colspan="3" bgcolor="maroon" align="center"> <font face="Verdana"
color="white" Size="2"><b> INJURED EMPLOYEE</b></td></tr>

<tr><td colspan="3"> <font face="Verdana" Size="2"> Home address Street
<asp:TextBox id="street" columns="90" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorStreet"
Display=Dynamic runat="server"

Text="The Street is required" ControlToValidate="Street">

</asp:RequiredFieldValidator>

</td></tr>

<tr><td> <font face="Verdana" Size="2"> City <asp:TextBox id="City"
columns="40" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorCity" Display=Dynamic
runat="server"

Text="The City is required" ControlToValidate="City">

</asp:RequiredFieldValidator>

</td><td> <font face="Verdana" Size="2"> State <asp:TextBox
id="AddressState" columns="2" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorADdressState"
Display=Dynamic runat="server"

Text="The State is required" ControlToValidate="AddressState">

</asp:RequiredFieldValidator>


</td> <td> <font face="Verdana" Size="2"> Zip <asp:TextBox id="Zip"
runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorZip" Display=Dynamic
runat="server"

Text="The Zip field is required" ControlToValidate="Zip">

</asp:RequiredFieldValidator>

</td></tr>

<tr><td> <font face="Verdana" Size="2">Date of Birth: <asp:textbox id=birth
columns="10" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorBirth" Display=Dynamic
runat="server"

Text="This field required" ControlToValidate="Birth">

</asp:RequiredFieldValidator>

</td><td><font face="Verdana" Size="2"> SSN:<asp:textbox id=SSN columns="11"
runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorSSN" Display=Dynamic
runat="server"

Text="The SSN field is required" ControlToValidate="SSN">

</asp:RequiredFieldValidator>


</td><td><font face="Verdana" Size="2"> Check one<asp:RadioButtonList
id="Sex" RepeatDirection="Horizontal" runat="server">

<asp:ListItem><font face="Verdana" Size="2">Male</asp:ListItem>

<asp:ListItem><font face="Verdana" Size="2">Female</asp:ListItem>
</asp:RadioButtonList>

</td></tr><td colspan="1"><font face="Verdana" Size="2"> Marital Status
<asp:RadiobuttonList id=Marital RepeatDirection="Vertical"

runat=server>

<asp:ListItem> <font face="Verdana" Size="2"> Single </asp:ListItem>

<asp:ListItem><font face="Verdana" Size="2"> Married </asp:ListItem>

<asp:ListItem><font face="Verdana" Size="2"> Widowed </asp:ListItem>

<asp:ListItem><font face="Verdana" Size="2">
Divorced</asp:ListItem></asp:RadioButtonList>

</td><td colspan="2"><font face="Verdana" Size="2"> Phone Number where
Employee can be Contacted: <asp:TextBox id=contactnumber runat=server/>

</td></tr><tr><td colspan="3"> <font face="Verdana" Size="2"> Job
Description - Choose One <Asp:DropDownList id=Job runat=server>

<asp:ListItem Text="Choose One"/>

<asp:ListItem Text="Clerical"/>

<asp:ListItem Text="Driver"/>

<asp:ListItem Text="Door Manufacturing"/>

<asp:ListItem Text="Installed Sales"/>

<asp:ListItem Text="Manager"/>

<asp:ListItem Text="Puller"/>

<asp:ListItem Text="Sales"/>

<asp:ListItem Text="Shop Tech"/>

<asp:ListItem Text="Truss Manufacturing"/>

<asp:ListItem Text="Yard Worker"/>

<asp:ListItem Text="Warehouse Worker"/>

<asp:ListItem Text="Window Manufacturing"/>

</asp:DropDownList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorJob" Display=Dynamic
runat="server"

Text="This field required" ControlToValidate="Job">

</asp:RequiredFieldValidator>


</td></tr><tr><td colspan="2"> <font face="Verdana" Size="2"> Supervisor's
Name <Asp:TextBox id=Supervisor Columns = "40" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorSupervisor"
Display=Dynamic runat="server"

Text="This field required" ControlToValidate="Supervisor">

</asp:RequiredFieldValidator>


</td><td> <font face="Verdana" Size="2">Time Worked Per Week Hours

<asp:TextBox id=hours Columns="1" runat=server/><br>

<asp:RequiredFieldValidator id="RequiredFieldValidatorHours" Display=Dynamic
runat="server"

Text="This field required" ControlToValidate="Hours">

</asp:RequiredFieldValidator>

<font face="Verdana" Size="2">Days &nbsp<Asp:TextBox id=Days columns="1"
runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorDays" Display=Dynamic
runat="server"

Text="This field required" ControlToValidate="Days">

</asp:RequiredFieldValidator>


<tr><td colspan="3" bgcolor="MAROON" align="center"> <font face="Verdana"
Size="2" COLOR="WHITE"><b> INJURY OR ILLNESS</b></td></tr>

</td></tr> <tr><td colspan="3"><font face="Verdana" Size="2"> Which part of
the Body Was Injured? (If leg, hand or arm, specify left or right. If
finger, specify which)

<asp:textbox id="part" columns = "40" runat = server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorPart" Display=Dynamic
runat="server"

Text="This field required" ControlToValidate="Part">

</asp:RequiredFieldValidator>

</td></tr> <tr><td colspan="3">

<font face="Verdana" Size="2"> What was the Nature of the Injury? - Choose
one

<asp:DropDownList id="nature" runat=server>

<asp:ListItem Text="Choose One"/>

<asp:ListItem Text="Abdominal Strain"/>

<asp:ListItem Text="Ankle Sprain"/>

<asp:ListItem Text="Back Strain"/>

<asp:ListItem Text="Arm Strain"/>

<asp:ListItem Text="Contusion"/>

<asp:ListItem Text="Embedded Foreign Object"/>

<asp:ListItem Text="Foot Fracture"/>

<asp:ListItem Text="Foreign substance in eye"/>

<asp:ListItem Text="Hand/Finger Fracture"/>

<asp:ListItem Text="Hand/Finger Smash"/>

<asp:ListItem Text="Laceration"/>

<asp:ListItem Text="Leg Fracture"/>

<asp:ListItem Text="Puncture Wound"/>

<asp:ListItem Text="Repetitive Motion Injury"/>

<asp:ListItem Text="Shoulder Strain"/>

<asp:ListItem Text="Struck By Lumber"/>

<asp:ListItem Text="Torn Tendon"/>

<asp:ListItem Text="Other"/>

</asp:DropDownList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorNature" runat="server"

Text="You must answer this question" ControlToValidate="nature">

</asp:RequiredFieldValidator>

</td></tr><tr><td colspan="3" valign="center">

<font face="Verdana" Size="2"> Injury/Illness Description:

<asp:textbox TextMode="MultiLine" Rows="2" columns= "65" id="Description"
runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorDescrip"
runat="server"

Text="You must answer this question" ControlToValidate="Description">

</asp:RequiredFieldValidator>

</td></tr><tr><td><font face="Verdana" Size="2"> Initial Medical Treatment:

<asp:RadioButtonList font-name="verdana" font-size="10 pt" id=Initial
runat="server">

<asp:ListItem>ER Treated & Released</asp:ListItem>

<asp:ListItem>Hospitalized less than 24 hours</asp:ListItem>

<asp:ListItem>Hospitalized more than 24 hours</asp:ListItem>

<asp:ListItem>Physician/Clinic</asp:ListItem>

<asp:ListItem>Minor/Onsite</asp:ListItem>

<asp:ListItem>None</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorInitial"
runat="server"

Text="You must answer this question" ControlToValidate="Initial">

</asp:RequiredFieldValidator>





</td><td colspan="2" valign="top"><font face="Verdana" Size="2"> What Type
of Medical Provider Performed Treatment?

<asp:RadioButtonList font-name="verdana" font-size="10 pt" id=Provider
runat="server">

<asp:ListItem>Hospital</asp:ListItem>

<asp:ListItem>Clinic</asp:ListItem>

<asp:ListItem>Physician</asp:ListItem>


</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorProvider"
runat="server"

Text="You must answer this question" ControlToValidate="Provider">

</asp:RequiredFieldValidator>

<br>

<font face="Verdana" Size="2"> Was Employee admitted into a Hospital?

<asp:RadioButtonList font-name="verdana" font-size="10 pt" id=Admitted
runat="server">

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorAdmitted"
runat="server"

Text="You must answer this question" ControlToValidate="Admitted">

</asp:RequiredFieldValidator>

</td></tr><tr><td colspan="3"><font face="Verdana" Size="2">Medical
Provider - Name:

<asp:TextBox Columns = "65" id=ProviderName runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorProviderName"
runat="server"

Text="You must answer this question" ControlToValidate="ProviderName">

</asp:RequiredFieldValidator>

</td></tr><tr><td colspan="3"><font face="Verdana" Size="2">Medical
Provider - Address:

<asp:TextBox Columns = "65" id=ProviderStreet runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorProviderStreet"
runat="server"

Text="You must answer this question" ControlToValidate="ProviderStreet">

</asp:RequiredFieldValidator>

</td></tr><tr><td colspan="3"><font face="Verdana" Size="2">Medical
Provider - City State Zip:

<asp:TextBox Columns = "65" id=ProviderCity runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorProviderCity"
runat="server"

Text="You must answer this question" ControlToValidate="ProviderCity">

</asp:RequiredFieldValidator>

</td></tr><tr><td colspan="3"><font face="Verdana" Size="2">Medical
Provider - Phone:

<asp:TextBox id=ProviderPhone runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorProviderPhone"
runat="server"

Text="You must answer this question" ControlToValidate="ProviderPhone">

</asp:RequiredFieldValidator>





</td></tr>

<tr><td colspan="3" bgcolor="MAROON" align="center"> <font face="Verdana"
Size="2" COLOR="WHITE"><strong>ACCIDENT DETAILS</strong></td></tr>

</td></tr>

<tr><td colspan="3"> <font face="Verdana" Size="2"> Give a Full Description
of the Accident:<font Size="1"> (Be as Complete as Possible)

<asp:TextBox TextMode="MultiLine" Rows="5" columns= "85" id=Full
runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorFull" runat="server"

Text="You must answer this question" ControlToValidate="Full">

</asp:RequiredFieldValidator>

</td></tr> <tr><td colspan="3"><font face="Verdana" Size="2"> What Caused
the Injury?

<asp:TextBox id= caused columns="85" runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorCaused" runat="server"

Text="You must answer this question" ControlToValidate="Caused">

</asp:RequiredFieldValidator>

</td></tr> <tr><td><font face="Verdana" Size="2">Did the Accident Occur at
the Store or Plant?

<asp:RadioButtonList font-name="verdana" font-size="10 pt" id=Occur
runat="server">

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorOccur" runat="server"

Text="You must answer this question" ControlToValidate="Occur">

</asp:RequiredFieldValidator>

</td><td colspan="2" valign="top"> <font face="Verdana" Size="2"> If No,
where did the accident occur?

<asp:textBox Columns = "40" id=where runat=server/>

</td></tr> <tr><td><font face="Verdana" Size="2"> Accident Address:

<font face="Verdana" Size="2"> <br> Street <asp:TextBox columns="45"
id=accidentStreet runat=server/>

<br><asp:RequiredFieldValidator id="RequiredFieldValidatorAccidentStreet"
Display=Dynamic runat="server"

Text="Fill this in" ControlToValidate="AccidentStreet">

</asp:RequiredFieldValidator>

</td><td><font face="Verdana" Size="2"> City
&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp
State <br><asp:TextBox columns="20" id = AccidentCity runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorAccidentCity"
display=dynamic runat="server"

Text="Fill in this field" ControlToValidate="AccidentCity">

</asp:RequiredFieldValidator>

<font face="Verdana" Size="2"> <asp:TextBox columns="2" id=AccidentState
runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorAccidentState"
Display=Dynamic runat="server"

Text="You must fill in this field" ControlToValidate="AccidentState">

</asp:RequiredFieldValidator>

</td><td>

<font face="Verdana" Size="2">Zip <br><asp:TextBox columns = "10"
id=AccidentZip runat=server/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorAccidentZip"
Display=Dynamic runat="server"

Text="You must fill in this field" ControlToValidate="AccidentZip">

</asp:RequiredFieldValidator>



</td></tr> <tr><td valign="top"><font face="Verdana" Size="2"> Are Other WC
Claims Involved?

<asp:RadioButtonList font-name="verdana" font-size="10 pt" id=OtherClaims
RepeatDirection="Horizontal" Display=dynamic runat="server">

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorOtherClaims"
runat="server"

Text="Required" ControlToValidate="OtherClaims">

</asp:RequiredFieldValidator>

</td><td Valign="top"><font face="Verdana" Size="2"> Safety Devices
Provided?

<asp:RadioButtonList font-name="verdana" font-size="10 pt" id=SafetyDevices
RepeatDirection="horizontal" Display=dynamic runat="server">

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorSafetyDevices"
Display=dynamic runat="server"

Text="Required" ControlToValidate="SafetyDevices">

</asp:RequiredFieldValidator>

</td><td><font face="Verdana" Size="2"> Safety Devices Utilized?

<asp:RadioButtonList font-name="verdana" font-size="10 pt"
id=DevicesUtilized RepeatDirection="Horizontal" runat="server">

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorDevicesUtilized"
Display=dynamic runat="server"

Text="Required" ControlToValidate="DevicesUtilized">

</asp:RequiredFieldValidator>

</td></tr><tr><td><font face="Verdana" Size="2"> Was There a Witness?

<asp:RadioButtonList font-name="verdana" font-size="10 pt" id=Witness
RepeatDirection="Horizontal" Display=dynamic runat="server">

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorWitness"
runat="server"

Text="You must answer this question" ControlToValidate="Witness">

</asp:RequiredFieldValidator>

</td><td valign = "top"><font face="Verdana" Size="2">

If Yes, List Name: <asp:Textbox id="WitnessName" columns="40" runat=server/>

</td></tr>

<tr><td colspan="3" bgcolor="MAROON" align="center">

<font face="Verdana" Size="2" COLOR="WHITE"><strong>DISABILITY
STATUS</strong></td></tr>

</td><td colspan="3"><font face="Verdana" Size="2"> Did Employee Receive Pay
for Date of Injury?

<asp:RadioButtonList RepeatDirection="Horizontal" font-name="verdana"
font-size="10 pt" id=ReceivePay runat="server">

<asp:ListItem>Yes</asp:ListItem>

<asp:ListItem>No</asp:ListItem>

</asp:RadioButtonList>

<asp:RequiredFieldValidator id="RequiredFieldValidatorReceivePay"
runat="server"

Text="You must answer this question" ControlToValidate="ReceivePay">

</asp:RequiredFieldValidator>

</td></tr>

<tr><td colspan="3" bgcolor="MAROON" align="center">

<font face="Verdana" Size="2" COLOR="WHITE"><strong>ADDITIONAL COMMENTS &
INFORMATION</strong></td></tr>

<tr><td colspan="3"><font face="Verdana" Size="2"> Additional Comments

<asp:textbox TextMode= "Multiline" Rows= "5" columns= "80"

id="comments" runat=server width="730" height="40"/>

</td></tr>

<tr><td colspan="3"><font face="Verdana" Size="2">How can the above incident
be prevented from happening again?

<asp:textbox id=Prevented Textmode="Multiline" Rows = "3" Columns="80"
width="730" runat=server/>

<tr><td><font face="Verdana" Size="2"><br> Name of person submitting this
form:

<asp:textbox id="Submitter" valign="top" runat=server columns="40"/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorSubmit" runat="server"

Text="You must enter name" ControlToValidate="Submitter">

</asp:RequiredFieldValidator>

<font face="Verdana" Size="2"><br>Title: <asp:textbox id="Title"
valign="top" runat=server columns="40"/>

</td><td> <font face="Verdana" Size="2"> Wheeler's Division - Choose One
<Asp:DropDownList id=Location runat=server>

<asp:ListItem Text="Choose One"/>

<asp:ListItem Text="Riverside Truss Plant"/>

<asp:ListItem Text="Riverside Door Plant"/>

<asp:ListItem Text="Riverside Office"/>

<asp:ListItem Text="Rome Store"/>

<asp:ListItem Text="Calhoun Store"/>

<asp:ListItem Text="Dalton Store"/>

<asp:ListItem Text="Austell Store"/>

<asp:ListItem Text="Morrow Store"/>

<asp:ListItem Text="Installed Sales"/>

<asp:ListItem Text="Newnan Store"/>

<asp:ListItem Text="Cartersville Store"/>

<asp:ListItem Text="Winder Store"/>

<asp:ListItem Text="Jasper Store"/>

<asp:ListItem Text="Chelsea Store"/>

<asp:ListItem Text="Madison Store"/>

<asp:ListItem Text="Peterson Products"/>

<asp:ListItem Text="Lawrenceville"/>

<asp:ListItem Text="OAR Window Shop"/>

<asp:ListItem Text="Charlotte - Hoskins Rd"/>

<asp:ListItem Text="Charlotte - Westinghouse Blvd"/>

<asp:ListItem Text="Sales Support Center"/>

<asp:ListItem Text="Land Development"/>

</asp:DropDownList>


</td><td><br>

<font face="Verdana" Size="2">Date<br><asp:textbox id="Today" runat=server
columns="10"/>

<asp:RequiredFieldValidator id="RequiredFieldValidatorToday" runat="server"

Text="You must enter today's date" ControlToValidate="Today">

</asp:RequiredFieldValidator>





</Table>




<tr>

<td>

<asp:Button id="btnSendMail" text="Submit" OnClick="SendMailandDatabase"
runat="server" />

</td>

</tr>

<td valign=top> <table cellpadding=20><tr><td>

<asp:ValidationSummary ID="valSum" runat="server" ShowMessageBox="true"
ShowSummary="false" HeaderText="You must enter more information"
Font-Name="verdana" Font-Size="12" /> </td>



</form>





</body>

</html>
 
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