{"id":78,"date":"2025-08-01T11:39:23","date_gmt":"2025-08-01T17:39:23","guid":{"rendered":"https:\/\/ohs.skircr.com\/demo\/"},"modified":"2025-10-28T12:16:58","modified_gmt":"2025-10-28T18:16:58","slug":"demo","status":"publish","type":"page","link":"https:\/\/ohs.skircr.com\/fr\/","title":{"rendered":"&#8211;"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be 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#112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-file-btn-bg-color-hover: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_4' class='gform_anchor' tabindex='-1'><\/div>\n                        <div class='gform_heading'>\n                            <h2 class=\"gform_title\">Formulaire Sant\u00e9 et S\u00e9curit\u00e9 au Travail &#8211;  RCR<\/h2>\n                            <p class='gform_description'>D\u00e9claration d&rsquo;\u00e9v\u00e9nement accidentel<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_4'  action='\/fr\/wp-json\/wp\/v2\/pages\/78#gf_4' data-formid='4' novalidate>\n        <div id='gf_progressbar_wrapper_4' class='gf_progressbar_wrapper' data-start-at-zero=''>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>7<\/span><span class='gf_step_page_name'><\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_14' style='width:14%;'><span>14%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_4_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_4' class='gform_fields top_label form_sublabel_above description_below validation_below'><div id=\"field_4_64\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_64'>Phone<\/label><div class='ginput_container'><input name='input_64' id='input_4_64' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_4_64'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><fieldset id=\"field_4_40\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >S&#039;agit-il d&#039;un probl\u00e8me de s\u00e9curit\u00e9 imm\u00e9diat ?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_40'>\n\t\t\t<div class='gchoice gchoice_4_40_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='Yes'  id='choice_4_40_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_4_40\"   \/>\n\t\t\t\t\t<label for='choice_4_40_0' id='label_4_40_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_40_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_40' type='radio' value='No'  id='choice_4_40_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_40_1' id='label_4_40_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><div class='gfield_description' id='gfield_description_4_40'>Si vous r\u00e9pondez \u00ab\u202fOui\u00bb, vous pourrez compl\u00e9ter le rapport, mais vous devez d\u2019abord en informer votre gestionnaire ou superviseur.<\/div><\/fieldset><div id=\"field_4_41\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><script>\nif (top.location.href.indexOf('\/fr\/') == -1) {\n\tdocument.addEventListener(\"DOMContentLoaded\", function() {\n\t\tdocument.getElementById('gform_next_button_4_42').style.display = 'none';\t\t\t\t\t\t\t\t\t\t\t\t\t   \n\t\tvar radioInputYes = document.getElementById(\"choice_4_40_0\");\n\t\tradioInputYes.addEventListener(\"change\", function(event) {\n\t\t\taddYesFunction(event.target);\n\t\t});\n\t\n\t\tvar radioInputNo = document.getElementById(\"choice_4_40_1\");\n\t\tradioInputNo.addEventListener(\"change\", function(event) {\n\t\t\taddNoFunction(event.target);\n\t\t});\n\t});\n\t\n\tfunction addYesFunction(element) {\n\t\tdocument.getElementById('gform_next_button_4_42').style.display = 'none';\n\t\talert('Please take action to resolve the issue or notify your manager or supervisor before entering the report.');\n\t}\n\t\n\tfunction addNoFunction(element) {\n\t\t\/\/ Confirmation alert before proceeding\n\t\tvar confirmAction = confirm('Click OK if you have alerted your manager or supervisor before entering this report?');\n\t\t\n\t\tif (confirmAction) {\n\t\t\tdocument.getElementById('gform_next_button_4_42').style.display = 'block';\n\t\t} else {\n\t\t\tdocument.getElementById('gform_next_button_4_42').style.display = 'none';\n\t\t\tdocument.getElementById(\"choice_4_40_0\").checked = true;\n\t\t}\n\t}\n}\n<\/script>\n<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <input type='button' id='gform_next_button_4_42' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_2' class='gform_page' data-js='page-field-id-42' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_2' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_4_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom du d\u00e9clarant<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_1'>\n                            \n                            <span id='input_4_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_4_1_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_1.3' id='input_4_1_3' value=''   aria-required='true'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_4_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_4_1_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_1.6' id='input_4_1_6' value=''   aria-required='true'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_4_31\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_31'>Heure de l&#039;\u00e9v\u00e9nement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_31' id='input_4_31' type='text' value='04\/05\/2026' class='datepicker gform-datepicker mdy datepicker_no_icon gdatepicker-no-icon'   placeholder='04\/05\/2026mm\/dd\/yyyy04\/05\/2026' aria-describedby=\"input_4_31_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_4_31_date_format' class='screen-reader-text'>MM slash JJ slash AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_4_31' class='gform_hidden' value='https:\/\/ohs.skircr.com\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/div><fieldset id=\"field_4_32\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Heure de l&#039;\u00e9v\u00e9nement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_4_32'>\n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_4_32_1'>Heures<\/label>\n                            <input type='number' name='input_32[]' id='input_4_32_1' value='6'  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   \/> \n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_4_32_2'>Minutes<\/label>\n                            <input type='number' name='input_32[]' id='input_4_32_2' value='30'  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_32[]' id='input_4_32_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' selected='selected'>PM<\/option>\n                                <\/select> \n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_4_32_3'>AM\/PM<\/label>                                \n                           <\/div>\n                    <\/div><\/fieldset><div id=\"field_4_59\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_59'>Poste occup\u00e9e de la personne impliqu\u00e9e dans l\u2019\u00e9v\u00e9nement accidentel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_59' id='input_4_59' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_21' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_4_21' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_3' class='gform_page' data-js='page-field-id-21' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_3' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_4_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Station<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_7'>\n\t\t\t<div class='gchoice gchoice_4_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Fernie Alpine Resort | Lizard Creek Lodge'  id='choice_4_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_0' id='label_4_7_0' class='gform-field-label gform-field-label--type-inline'>Fernie Alpine Resort | Lizard Creek Lodge<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Kicking Horse Mountain Resort'  id='choice_4_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_1' id='label_4_7_1' class='gform-field-label gform-field-label--type-inline'>Kicking Horse Mountain Resort<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Kimberley Alpine Resort | Trickle Creek Lodge | Trickle Creek Golf Resort'  id='choice_4_7_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_2' id='label_4_7_2' class='gform-field-label gform-field-label--type-inline'>Kimberley Alpine Resort | Trickle Creek Lodge | Trickle Creek Golf Resort<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Mont-Sainte-Anne | Golf Grand Vallon'  id='choice_4_7_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_3' id='label_4_7_3' class='gform-field-label gform-field-label--type-inline'>Mont-Sainte-Anne | Golf le Grand Vallon<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Nakiska Ski Area | Winter Green Golf'  id='choice_4_7_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_4' id='label_4_7_4' class='gform-field-label gform-field-label--type-inline'>Nakiska Ski Area | Winter Green Golf<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='RCR Calgary Office'  id='choice_4_7_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_5' id='label_4_7_5' class='gform-field-label gform-field-label--type-inline'>RCR Calgary Office<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_7_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Stoneham Mountain Resort | Hotel Stoneham'  id='choice_4_7_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_7_6' id='label_4_7_6' class='gform-field-label gform-field-label--type-inline'>Station touristique Stoneham | H\u00f4tel Stoneham<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_22' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_4_22' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_4' class='gform_page' data-js='page-field-id-22' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_4' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_4_8\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >D\u00e9partement de la personne impliqu\u00e9e dans l\u2019\u00e9v\u00e8nement accidentel<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_8'>\n\t\t\t<div class='gchoice gchoice_4_8_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Administration'  id='choice_4_8_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_0' id='label_4_8_0' class='gform-field-label gform-field-label--type-inline'>Administration<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Food and Beverage'  id='choice_4_8_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_1' id='label_4_8_1' class='gform-field-label gform-field-label--type-inline'>Restauration<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Golf Course'  id='choice_4_8_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_2' id='label_4_8_2' class='gform-field-label gform-field-label--type-inline'>Golf<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Hotel'  id='choice_4_8_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_3' id='label_4_8_3' class='gform-field-label gform-field-label--type-inline'>Hotel<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Instructors | Guides | Daycare'  id='choice_4_8_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_4' id='label_4_8_4' class='gform-field-label gform-field-label--type-inline'>\u00c9cole des Sports | Garderie<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Lift Operations | Rail Park'  id='choice_4_8_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_5' id='label_4_8_5' class='gform-field-label gform-field-label--type-inline'>Op\u00e9rations des remont\u00e9es m\u00e9caniques<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Maintenance'  id='choice_4_8_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_6' id='label_4_8_6' class='gform-field-label gform-field-label--type-inline'>Entretien (Remont\u00e9es m\u00e9caniques, B\u00e2timents, \u00c9lect., etc.)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Mountain Operations'  id='choice_4_8_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_7' id='label_4_8_7' class='gform-field-label gform-field-label--type-inline'>Op\u00e9rations Montagne  (Remont\u00e9es M\u00e9caniques, Enneigement, Parc \u00e0 neige, Stationnement, etc.)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Mountain Safety'  id='choice_4_8_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_8' id='label_4_8_8' class='gform-field-label gform-field-label--type-inline'>Patrouille<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_8_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_8' type='radio' value='Rental | Retail | Repair'  id='choice_4_8_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_8_9' id='label_4_8_9' class='gform-field-label gform-field-label--type-inline'>Location | R\u00e9paration | Boutique<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_38' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_4_38' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_5' class='gform_page' data-js='page-field-id-38' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_5' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_4_28\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Type d&#039;\u00e9v\u00e9nement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_28'>\n\t\t\t<div class='gchoice gchoice_4_28_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Injury'  id='choice_4_28_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_28_0' id='label_4_28_0' class='gform-field-label gform-field-label--type-inline'>Blessure<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_28_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Property Damage'  id='choice_4_28_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_28_1' id='label_4_28_1' class='gform-field-label gform-field-label--type-inline'>Dommages mat\u00e9riels<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_28_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_28' type='radio' value='Near Miss'  id='choice_4_28_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_28_2' id='label_4_28_2' class='gform-field-label gform-field-label--type-inline'>Quasi-accident<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_12\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Type d&#039;\u00e9v\u00e9nement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_12'>\n\t\t\t<div class='gchoice gchoice_4_12_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Minor Injury - No Treatment Required'  id='choice_4_12_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_0' id='label_4_12_0' class='gform-field-label gform-field-label--type-inline'>Blessure mineure (Sans assistance)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='First Aid (Treated by Resort \/ Patrol)'  id='choice_4_12_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_1' id='label_4_12_1' class='gform-field-label gform-field-label--type-inline'>Premiers secours (\u00c0 la montagne)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_12_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_12' type='radio' value='Medical Aid (Treated at Hospital \/ Physio)'  id='choice_4_12_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_12_2' id='label_4_12_2' class='gform-field-label gform-field-label--type-inline'>Assistance m\u00e9dicale (Au centre de sant\u00e9)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_60\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Dommages mat\u00e9riels<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_60'>\n\t\t\t<div class='gchoice gchoice_4_60_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Vehicle'  id='choice_4_60_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_60_0' id='label_4_60_0' class='gform-field-label gform-field-label--type-inline'>V\u00e9hicule ou \u00e9quipement motoris\u00e9 (obligatoire)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_60_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Buildings'  id='choice_4_60_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_60_1' id='label_4_60_1' class='gform-field-label gform-field-label--type-inline'>B\u00e2timents<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_60_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Tools &amp; Equipment'  id='choice_4_60_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_60_2' id='label_4_60_2' class='gform-field-label gform-field-label--type-inline'>Outils et \u00e9quipements<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_60_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_60' type='radio' value='Infrastructure'  id='choice_4_60_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_60_3' id='label_4_60_3' class='gform-field-label gform-field-label--type-inline'>Bris d&rsquo;infrastructure (installations ou structures ext\u00e9rieures)<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_16\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Quasi-accident<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_16'>\n\t\t\t<div class='gchoice gchoice_4_16_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Injury'  id='choice_4_16_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_16_0' id='label_4_16_0' class='gform-field-label gform-field-label--type-inline'>Risque de blessure<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_16_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Vehicle'  id='choice_4_16_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_16_1' id='label_4_16_1' class='gform-field-label gform-field-label--type-inline'>Bris de vehicule<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_16_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Buildings'  id='choice_4_16_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_16_2' id='label_4_16_2' class='gform-field-label gform-field-label--type-inline'>Bris de batiment (Bureaux, ateliers, entrep\u00f4ts, salles)<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_16_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Tools &amp; Equipment'  id='choice_4_16_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_16_3' id='label_4_16_3' class='gform-field-label gform-field-label--type-inline'>Bris d&rsquo;outil ou \u00e9quipement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_16_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Infrastructure'  id='choice_4_16_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_16_4' id='label_4_16_4' class='gform-field-label gform-field-label--type-inline'>Infrastructure<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_16_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_16' type='radio' value='Other'  id='choice_4_16_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_16_5' id='label_4_16_5' class='gform-field-label gform-field-label--type-inline'>Autre<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_53' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dentt'  \/> <input type='button' id='gform_next_button_4_53' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_6' class='gform_page' data-js='page-field-id-53' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_6' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_4_17\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >Description de l&#039;\u00e9v\u00e9nement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_17'>\n\t\t\t<div class='gchoice gchoice_4_17_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Animal or Insect Bite'  id='choice_4_17_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_0' id='label_4_17_0' class='gform-field-label gform-field-label--type-inline'>Morsure d\u2019insecte ou d&rsquo;animal<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Assault'  id='choice_4_17_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_1' id='label_4_17_1' class='gform-field-label gform-field-label--type-inline'>Agression<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Avalanche'  id='choice_4_17_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_2' id='label_4_17_2' class='gform-field-label gform-field-label--type-inline'>Avalanche<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Burn'  id='choice_4_17_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_3' id='label_4_17_3' class='gform-field-label gform-field-label--type-inline'>Burn<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_4'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Chemical or Fuel Spill'  id='choice_4_17_4' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_4' id='label_4_17_4' class='gform-field-label gform-field-label--type-inline'>Chemical or Fuel Spill<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_5'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Cold or Heat Exposure'  id='choice_4_17_5' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_5' id='label_4_17_5' class='gform-field-label gform-field-label--type-inline'>Cold or Heat Exposure<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_6'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Collision'  id='choice_4_17_6' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_6' id='label_4_17_6' class='gform-field-label gform-field-label--type-inline'>Collision<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_7'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Crush \/ Pinch'  id='choice_4_17_7' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_7' id='label_4_17_7' class='gform-field-label gform-field-label--type-inline'>Crush \/ Pinch<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_8'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Cut \/ Abrasion \/ Scrape'  id='choice_4_17_8' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_8' id='label_4_17_8' class='gform-field-label gform-field-label--type-inline'>Cut \/ Abrasion \/ Scrape<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_9'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Dropped Object'  id='choice_4_17_9' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_9' id='label_4_17_9' class='gform-field-label gform-field-label--type-inline'>Dropped Object<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_10'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Electrocution'  id='choice_4_17_10' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_10' id='label_4_17_10' class='gform-field-label gform-field-label--type-inline'>Electrocution<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_11'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Fall'  id='choice_4_17_11' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_11' id='label_4_17_11' class='gform-field-label gform-field-label--type-inline'>Fall<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_12'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Fall from height'  id='choice_4_17_12' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_12' id='label_4_17_12' class='gform-field-label gform-field-label--type-inline'>Fall from height<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_13'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Fire or Explosion'  id='choice_4_17_13' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_13' id='label_4_17_13' class='gform-field-label gform-field-label--type-inline'>Fire or Explosion<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_14'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Flood'  id='choice_4_17_14' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_14' id='label_4_17_14' class='gform-field-label gform-field-label--type-inline'>Flood<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_15'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Freeze'  id='choice_4_17_15' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_15' id='label_4_17_15' class='gform-field-label gform-field-label--type-inline'>Freeze<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_16'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Harmful Substance Exposure'  id='choice_4_17_16' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_16' id='label_4_17_16' class='gform-field-label gform-field-label--type-inline'>Harmful Substance Exposure<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_17'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Loss of Control'  id='choice_4_17_17' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_17' id='label_4_17_17' class='gform-field-label gform-field-label--type-inline'>Loss of Control<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_18'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Medical Condition'  id='choice_4_17_18' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_18' id='label_4_17_18' class='gform-field-label gform-field-label--type-inline'>Medical Condition<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_19'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Release of Stored Energy'  id='choice_4_17_19' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_19' id='label_4_17_19' class='gform-field-label gform-field-label--type-inline'>Release of Stored Energy<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_20'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Repetitive Strain'  id='choice_4_17_20' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_20' id='label_4_17_20' class='gform-field-label gform-field-label--type-inline'>Repetitive Strain<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_21'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Slip or Trip'  id='choice_4_17_21' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_21' id='label_4_17_21' class='gform-field-label gform-field-label--type-inline'>Slip or Trip<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_22'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Strain'  id='choice_4_17_22' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_22' id='label_4_17_22' class='gform-field-label gform-field-label--type-inline'>Strain<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_17_23'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_17' type='radio' value='Struck'  id='choice_4_17_23' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_17_23' id='label_4_17_23' class='gform-field-label gform-field-label--type-inline'>Struck<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_4_39\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_4_39'>Description d\u2019\u00e9v\u00e9nement. Veuillez expliquer \u00e0 quel endroit l\u2019\u00e9v\u00e9nement est survenu, ce qui s\u2019est produit et de quelle mani\u00e8re. \nMERCI DE NE PAS INDIQUER le nom des employ\u00e9s concern\u00e9s dans ce champ.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_39' id='input_4_39' class='textarea large'  aria-describedby=\"gfield_description_4_39\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><div class='gfield_description' id='gfield_description_4_39'>Pr\u00e9cisez l\u2019endroit exact o\u00f9 l\u2019\u00e9v\u00e9nement a eu lieu, par exemple : piste de ski ou local du chalet principal.<\/div><\/div><fieldset id=\"field_4_61\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nom du t\u00e9moin<\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_4_61'>\n                            \n                            <span id='input_4_61_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <label for='input_4_61_3' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                    <input type='text' name='input_61.3' id='input_4_61_3' value=''   aria-required='false'    autocomplete=\"given-name\" \/>\n                                                <\/span>\n                            \n                            <span id='input_4_61_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                            <label for='input_4_61_6' class='gform-field-label gform-field-label--type-sub '>Nom<\/label>\n                                                            <input type='text' name='input_61.6' id='input_4_61_6' value=''   aria-required='false'    autocomplete=\"family-name\" \/>\n                                                        <\/span>\n                            \n                        <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <input type='button' id='gform_previous_button_4_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' value='Pr\u00e9c\u00e9dent'  \/> <input type='button' id='gform_next_button_4_58' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' value='Suivant'  \/> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_4_7' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_4_7' class='gform_fields top_label form_sublabel_above description_below validation_below'><fieldset id=\"field_4_19\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00c9v\u00e9nnement impliquant: Ski, Planche \u00e0 neige, ou V\u00e9lo <span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_19'>\n\t\t\t<div class='gchoice gchoice_4_19_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='Yes'  id='choice_4_19_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_19_0' id='label_4_19_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_19_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_19' type='radio' value='No'  id='choice_4_19_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_19_1' id='label_4_19_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00c9v\u00e9nnement impliquant: V\u00e9hicule ou \u00e9quipement motoris\u00e9<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_63'>\n\t\t\t<div class='gchoice gchoice_4_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Yes'  id='choice_4_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_63_0' id='label_4_63_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='No'  id='choice_4_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_63_1' id='label_4_63_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_4_30\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >D\u00e9tails Blessure<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(obligatoire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_4_30'>\n\t\t\t<div class='gchoice gchoice_4_30_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Arm | Wrist | Hand | Finger'  id='choice_4_30_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_30_0' id='label_4_30_0' class='gform-field-label gform-field-label--type-inline'>Bras | Poignet | Main | Doigt<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_30_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Back | Shoulder'  id='choice_4_30_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_30_1' id='label_4_30_1' class='gform-field-label gform-field-label--type-inline'>Dos | \u00c9paule<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_30_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_30' type='radio' value='Chest | Abdomen | Stomach'  id='choice_4_30_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_4_30_2' id='label_4_30_2' class='gform-field-label gform-field-label--type-inline'>Poitrine | Abdomen | Estomac<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_4_30_3'>\n\t\t\t\t\t<input 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