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1 forms found in the DOM

Name: field — POST /?tx_powermail_pi1%5Baction%5D=checkCreate&tx_powermail_pi1%5Bcontroller%5D=Form&cHash=87da0584009deb61cb0ef6fd415a7799#c1

<form data-powermail-validate="data-powermail-validate" data-validate="html5" data-powermail-ajax="true" data-powermail-form="1" data-powermail-ajax-uri="/sukces" enctype="multipart/form-data" method="post" name="field"
  class="powermail-form powermail_form powermail_form_1 powermail-form   " action="/?tx_powermail_pi1%5Baction%5D=checkCreate&amp;tx_powermail_pi1%5Bcontroller%5D=Form&amp;cHash=87da0584009deb61cb0ef6fd415a7799#c1" novalidate="novalidate">
  <div><input type="hidden" name="tx_powermail_pi1[__referrer][@extension]" value="Powermail"><input type="hidden" name="tx_powermail_pi1[__referrer][@controller]" value="Form"><input type="hidden" name="tx_powermail_pi1[__referrer][@action]"
      value="form"><input type="hidden" name="tx_powermail_pi1[__referrer][arguments]" value="YTowOnt9cdb511ddcb0919963578eca98fa1a01a47af0a1e"><input type="hidden" name="tx_powermail_pi1[__referrer][@request]"
      value="{&quot;@extension&quot;:&quot;Powermail&quot;,&quot;@controller&quot;:&quot;Form&quot;,&quot;@action&quot;:&quot;form&quot;}6a7c84259966c616bce3aa55b99d015d5eb0f02b"><input type="hidden" name="tx_powermail_pi1[__trustedProperties]"
      value="{&quot;field&quot;:{&quot;imieinazwisko&quot;:1,&quot;datazdarzenia&quot;:1,&quot;miejscezdarzenia&quot;:1,&quot;opiszdarzenia&quot;:1,&quot;marker&quot;:{&quot;name&quot;:[1],&quot;type&quot;:[1],&quot;tmp_name&quot;:[1],&quot;error&quot;:[1],&quot;size&quot;:[1]},&quot;__hp&quot;:1},&quot;mail&quot;:{&quot;form&quot;:1}}39fa5af973ff43d3a044a36dd38fbbaca044924c">
  </div>
  <h3 class="powermail-form-title">Dbamy o twoje bezpieczeństwo. <br>Jeśli zauważyłeś zagrożenie w pracy skontaktuj się z działem BHP.</h3>
  <fieldset class="powermail_fieldset powermail-fieldset powermail-fieldset-1 nolabel">
    <div class="powermail-field-wrapper powermail-field-wrapper-type-input powermail-field-wrapper-imieinazwisko  "><label for="powermail-field-imieinazwisko" class="powermail_label" title=""> imię i nazwisko: </label>
      <div class="powermail_field"><input class="powermail_input  " id="powermail_field-imieinazwisko" type="text" name="tx_powermail_pi1[field][imieinazwisko]" value=""></div>
    </div>
    <div class="powermail-field-wrapper powermail-field-wrapper-type-date powermail-field-wrapper-datazdarzenia  "><label for="powermail-field-datazdarzenia" class="powermail_label" title=""> data zdarzenia: </label>
      <div class="powermail_field"><input data-datepicker-format="YYYY-MM-DD" class="powermail_date  " id="powermail_field-datazdarzenia" type="date" name="tx_powermail_pi1[field][datazdarzenia]" value=""></div>
    </div>
    <div class="powermail-field-wrapper powermail-field-wrapper-type-input powermail-field-wrapper-miejscezdarzenia  "><label for="powermail-field-miejscezdarzenia" class="powermail_label" title=""> miejsce zdarzenia: </label>
      <div class="powermail_field"><input class="powermail_input  " id="powermail_field-miejscezdarzenia" type="text" name="tx_powermail_pi1[field][miejscezdarzenia]" value=""></div>
    </div>
    <div class="powermail-field-wrapper powermail-field-wrapper-type-textarea powermail-field-wrapper-opiszdarzenia  "><label for="powermail-field-opiszdarzenia" class="powermail_label" title=""> opis zdarzenia: </label>
      <div class="powermail_field"><textarea rows="5" cols="20" class="powermail_textarea  " id="powermail_field-opiszdarzenia" name="tx_powermail_pi1[field][opiszdarzenia]"></textarea></div>
    </div>
    <div class="powermail-field-wrapper powermail-field-wrapper-type-file powermail-field-wrapper-marker  "><label for="powermail-field-marker" class="powermail_label" title=""> wyślij zdjęcia </label>
      <div class="powermail_field"><input multiple="multiple" accept=".jpg,.jpeg,.gif,.png,.tif,.txt,.doc,.docx,.xls,.xlsx,.ppt,.pptx,.pdf,.mpg,.mpeg,.avi,.mp3,.zip,.rar,.ace,.csv,.svg" data-powermail-powermailfilesize="10485760,marker"
          data-powermail-powermailfilesize-message="The file, that you want to upload is too large!" data-powermail-powermailfileextensions="marker"
          data-powermail-powermailfileextensions-message="It's not allowed to upload a file with this extension!" class="powermail_file powermail-file  " id="powermail_field-marker" type="file" name="tx_powermail_pi1[field][marker][]"></div>
    </div>
    <div class="powermail-field-wrapper powermail-field-wrapper-type-submit powermail-field-wrapper-wyslij  ">
      <div class="powermail_field "><input class="powermail_submit" type="submit" value="wyślij"></div>
    </div>
  </fieldset><input class="powermail_form_uid" type="hidden" name="tx_powermail_pi1[mail][form]" value="1">
  <div style="margin-left: -99999px; position: absolute;"><label for="powermail_hp_1"> Don't fill this field! </label><input autocomplete="new-powermail-hp-1" aria-hidden="true" id="powermail_hp_1" tabindex="-1" type="text"
      name="tx_powermail_pi1[field][__hp]" value=""></div>
</form>

Text Content

DBAMY O TWOJE BEZPIECZEŃSTWO.
JEŚLI ZAUWAŻYŁEŚ ZAGROŻENIE W PRACY SKONTAKTUJ SIĘ Z DZIAŁEM BHP.

imię i nazwisko:

data zdarzenia:

miejsce zdarzenia:

opis zdarzenia:

wyślij zdjęcia


Don't fill this field!

REMONDIS S.p. z. o o.
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