// ==============================================
// Copyright 2005 by Liang Pei
// ==============================================

function showSurvey(){
	document.writeln('<form action="../action.php" method="post" target="_blank">');
	document.writeln('<table border="0" align="center">');
    document.writeln('<tr><td class="surv">DPH employee?</td> <td><select name="dph" class="surv"> <option value="0">-</option> <option value="y">Yes</option> <option value="n">No</option></select></td></tr>');
	document.writeln('<tr><td class="surv">CT  state employee?</td> <td><select name="state" class="surv"> <option value="0">-</option>  <option value="y">Yes</option> <option value="n">No</option></select></td>  </tr>');
	document.writeln('<tr><td class="surv">Gender:</td><td><select name="gender" class="surv">  <option value="0">-</option> <option value="m">Male</option> <option value="f">Female</option></select></td>   </tr>');
	document.writeln('<tr><td class="surv">Age group:</td><td><select name="age" class="surv"> <option value="0">-</option> <option value="1">&lt;20</option> <option value="2">20-29</option> <option value="3">30-39</option> <option value="4">40-49</option> <option value="5">50-59</option> <option value="6">&gt;=60</option></select></td></tr>');
	document.writeln('<tr><td class="surv">Usefulness<br>of this site:</td><td><select name="useful" class="surv">  <option value="0">-</option> <option value="1">Not Good</option> <option value="2">Good</option> <option value="3">Excellent</option></select></td>   </tr>');
	document.writeln('</table><p align="center"><input value="Submit" type="submit" class="surv"/></p></form>');
	}
showSurvey();