<?php use yii\helpers\Html; ?>
<div class="dt078be-form outputpdf">
	<?= $this->render('@frontend/views/common/_pdfheader', ['title' => 'Medication Declaration Form']); ?>
<table class="Table notbb norb nolb">
	<tr>
		<th class="DarkerBlue">Name</th>
		<td><?= $model->employeen ? $model->employeen->fullname : false ?></td>
		<th colspan="2" class="DarkerBlue">National Ins No</th>
		<td colspan="2"><?= $model->natindno ?></td>
	</tr>
	<tr> 
		<th width="16.667%" class="DarkerBlue">Start Date</th>
		<td width="16.667%"><?= $model->startdate ?></td>
		<th width="16.667%" class="DarkerBlue">Finish Date</th>
		<td width="16.667%"><?= $model->finishdate ?></td>
		<th width="16.667%" class="DarkerBlue">Duration</th>
		<td width="16.667%"><?= $model->duration ?></td>
	</tr>
</table>
<br />
<table class="Table notbb norb nolb">
	<tr>
		<td colspan="4">I declare that I am taking the following drug/s obtained privately &apos;over the counter&apos;.  I am/am not aware of their likely effect upon the performance of my rostered duties.</td>
		<td colspan="1"><?= $model->selfpescribed == 0 ? 'NO' : 'YES' ?></td>
	</tr>
	<tr>
		<td colspan="4">I declare that I am taking the following drug(s) prescribed to me by a Registered Medical Practitioner / Dentist and that I have been in formed of their likely effect upon the performance of my rostered duties</td>
		<td><?= $model->pescribed == 0 ? 'NO' : 'YES' ?></td>
	</tr>
	<tr>
		<td colspan="5">I declare that the above named employee has fully informed me of the medication he/she is taking and that the following action requires to be taken as a result of the effects:</td>
	</tr>
	<tr>
		<th colspan="5" class="DarkerBlue">Reason</th>
	</tr>
	<tr>
		<td colspan="5" ><?= $model->reason ? $model->reason : '&nbsp;'?></td>
	</tr>
	<tr>
		<th colspan="5" class="DarkerBlue">Drug or medication being used:</th>
	</tr>
	<tr>
		<td colspan="5"><?= $model->medication? $model->medication : '&nbsp;' ?></td>
	</tr>
	<tr>
		<th colspan="5" class="DarkerBlue">Advice from Medical Express [Where  applicable]</th>
	</tr>
	<tr>
		<td colspan="5" ><?= $model->advice ? $model->advice : '&nbsp;' ?></td>
	</tr>
	<tr>
		<th colspan="4" class="DarkerBlue">The Operative May Work</th>
		<td><?= $model->maywork ?></td>
	</tr>
	<tr>
		<th colspan="4" class="DarkerBlue">The operative must be accompanied at all time</th>
		<td><?= $model->accompanied ?></td>
	</tr>
	<tr>
		<th colspan="4" class="DarkerBlue">The operative may not take part in work of a safety critical nature</th>
		<td><?= $model->safety ?></td>
	</tr>
	<tr>
		<th colspan="4" class="DarkerBlue">The operative has been stood down	</th>
		<td><?= $model->stooddown ?></td>
	</tr>
	<tr>
		<th width="25%" class="DarkerBlue">Signed</th>
		<td width="30%" ><?= HTML::IMG($model->opsigned, ['alt' => 'no image', 'width' => '200px']) ?></td>
		<th width="20%" class="DarkerBlue">Name</th>
		<td width="15%" ><?= $model->op ? $model->op->fullname : false ?></td>
		<th width="20%" class="DarkerBlue">Operative</th>
	</tr>
	<tr>
		<th class="DarkerBlue">Signed</th>
		<td><?= HTML::IMG($model->supsigned, ['alt' => 'no image', 'width' => '200px']) ?></td>
		<th class="DarkerBlue">Name</th>
		<td><?= $model->sup ? $model->sup->fullname : null ?></td>
		<th class="DarkerBlue">Supervisor</th>
	</tr>
	<tr>
		<th class="DarkerBlue">Date</th>
		<td><?= $model->date ?></td>
		<td colspan="3">&nbsp;</td>
	</tr>
</table>

</div>