MW EM on Prop

*** Emergency Services on Property ***

Date of Incident:[date name="variable_1" default=""]
Time of Emergency Services' Arrival:[text name="variable_2" default="sample text"]
Brief Synopsis of the Incident:
[textarea name="variable_3" default=""]

Disposition of the Incident:
[textarea name="variable_4" default="PT was transported to the hospital by Twin Mountain Fire & Rescue"]

LPO Making the Notification: [select name="variable_5" value=" |Supervisor Hageman|LPO Hogan|LPO Smith|LPO Seaman|LPO Champagne|LPO Bogie|LPO Tyler|DoLP Monahan"]