[%- USE T8 %]
[%- USE L %]
[% USE HTML %]
<h1>[% title %]</h1>

 <script type="text/javascript">
   $(function(){ document.Form.subject.focus(); });
 </script>

 <form action="fu.pl" method="post" name="Form" id="form">
  <p>
   <table>
    <tr>
     <td align="right">[% 'Created for' | $T8 %]</td>
     <td>
      <select name="created_for">
       <option></option>
       [%- FOREACH row = EMPLOYEES %]
       <option value="[% HTML.escape(row.id) %]">
        [%- IF row.name %]
        [%- HTML.escape(row.name) %] ([% HTML.escape(row.login) %])
        [%- ELSE %]
        [%- HTML.escape(row.login) %]
        [%- END %]
       </option>
       [%- END %]
      </select>
     </td>
    </tr>

    <tr>
     <td align="right">[% 'Subject' | $T8 %]</td>
     <td><input name="subject" size="20"></td>
    </tr>

    <tr>
     <td align="right">[% 'Body' | $T8 %]</td>
     <td><input name="body" size="20"></td>
    </tr>

    <tr>
     <td align="right">[% 'Reference' | $T8 %]</td>
     <td><input name="reference" size="20"></td>
    </tr>

    <tr>
     <td align="right">[% 'Follow-Up Date' | $T8 %]</td>
     <td>
      [% 'From' | $T8 %]
      [% L.date_tag('follow_up_date_from') %]
      [% 'To (time)' | $T8 %]
      [% L.date_tag('follow_up_date_to') %]
     </td>
    </tr>

    <tr>
     <td align="right">[% 'Created on' | $T8 %]</td>
     <td>
      [% 'From' | $T8 %]
      [% L.date_tag('itime_from') %]
      [% 'To (time)' | $T8 %]
      [% L.date_tag('itime_to') %]
     </td>
    </tr>

    <tr>
     <td align="right">[% 'Include in Report' | $T8 %]</td>
     <td>

      <table>
       <tr>
        <td>
         <input type="checkbox" name="due_only" id="due_only" value="1" checked>
         <label for="due_only">[% 'Only due follow-ups' | $T8 %]</label>
        </td>

        <td>
         <input type="checkbox" name="all_users" id="all_users" value="1" checked>
         <label for="all_users">[% 'Other users\' follow-ups' | $T8 %]</label>
        </td>
       </tr>

       <tr>
        <td>
         <input type="checkbox" name="not_done" id="not_done" value="1" checked>
         <label for="not_done">[% 'Not done yet' | $T8 %]</label>
        </td>

        <td>
         <input type="checkbox" name="done" id="done" value="1">
         <label for="done">[% 'Done' | $T8 %]</label>
        </td>
       </tr>
      </table>

     </td>
    </tr>

   </table>
  </p>
 </form>