{"id":2705,"date":"2024-04-24T16:07:21","date_gmt":"2024-04-24T22:07:21","guid":{"rendered":"https:\/\/crtecnica.com\/demoinstitucion\/?page_id=2705"},"modified":"2024-07-10T14:19:12","modified_gmt":"2024-07-10T20:19:12","slug":"reporte-de-incidente","status":"publish","type":"page","link":"https:\/\/crtecnica.com\/demoinstitucion\/reporte-de-incidente\/","title":{"rendered":"Reporte de incidente"},"content":{"rendered":"\n<h2>\n\t\tREPORTE DE INCIDENTE\n\t<\/h2>\n<h2>\n\t\tPara reportar a Direcci\u00f3n y Orientaci\u00f3n\n\t<\/h2>\n\t<script type=\"text\/javascript\">var 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 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gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_59' style='display:none'>\n                        <div class='gform_heading'>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_59'  action='\/demoinstitucion\/wp-json\/wp\/v2\/pages\/2705' data-formid='59' novalidate><input type=\"hidden\" value=\"0\" name=\"gpps_page_progression_59\" \/>\n                        <div class='gform-body gform_body'><div id='gform_fields_59' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_59_3\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_3\" ><label class='gfield_label gform-field-label' for='input_59_3'>A\u00f1o lectivo<\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_3' id='input_59_3' type='text' value='2026' class='small'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_26\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_26\" ><label class='gfield_label gform-field-label' for='input_59_26'>Nombre del docente<\/label><div class='ginput_container ginput_container_select'><select name='input_26' id='input_59_26' class='large gfield_select'  aria-describedby=\"gfield_description_59_26\"   aria-invalid=\"false\" ><option value='Alex Gabriel Ruiz P\u00e9rez' selected='selected'>Alex Gabriel Ruiz P\u00e9rez<\/option><option value='Ana Isabel Moreno Fern\u00e1ndez' >Ana Isabel Moreno Fern\u00e1ndez<\/option><option value='Andrea Camila Mart\u00ednez Hern\u00e1ndez' >Andrea Camila Mart\u00ednez Hern\u00e1ndez<\/option><option value='Axel Sebasti\u00e1n Romero \u00c1lvarez' >Axel Sebasti\u00e1n Romero \u00c1lvarez<\/option><option value='Camila Alejandra Herrera P\u00e9rez' >Camila Alejandra Herrera P\u00e9rez<\/option><option value='Clara Emilia Santos \u00c1lvarez' >Clara Emilia Santos \u00c1lvarez<\/option><option value='Daniel Nicol\u00e1s Guti\u00e9rrez S\u00e1nchez' >Daniel Nicol\u00e1s Guti\u00e9rrez S\u00e1nchez<\/option><option value='David Miguel Morales P\u00e9rez' >David Miguel Morales P\u00e9rez<\/option><option value='Javier Andr\u00e9s Navarro Ruiz' >Javier Andr\u00e9s Navarro Ruiz<\/option><option value='Laura Sof\u00eda Castro Murillo' >Laura Sof\u00eda Castro Murillo<\/option><option value='Lucas Mateo Rodr\u00edguez Mart\u00ednez' >Lucas Mateo Rodr\u00edguez Mart\u00ednez<\/option><option value='Luc\u00eda Emilia Rodr\u00edguez Mart\u00ednez' >Luc\u00eda Emilia Rodr\u00edguez Mart\u00ednez<\/option><option value='Marcos Antonio Santos \u00c1lvarez' >Marcos Antonio Santos \u00c1lvarez<\/option><option value='Mar\u00eda Fernanda Navarro Rojas' >Mar\u00eda Fernanda Navarro Rojas<\/option><option value='Mariana Andrea Blanco Picado' >Mariana Andrea Blanco Picado<\/option><option value='Mart\u00edn Sebasti\u00e1n Castro Gonz\u00e1lez' >Mart\u00edn Sebasti\u00e1n Castro Gonz\u00e1lez<\/option><option value='Mateo Andr\u00e9s Hern\u00e1ndez L\u00f3pez' >Mateo Andr\u00e9s Hern\u00e1ndez L\u00f3pez<\/option><option value='Pablo Daniel Delgado Romero' >Pablo Daniel Delgado Romero<\/option><option value='Patricio Nicol\u00e1s Gonz\u00e1lez L\u00f3pez' >Patricio Nicol\u00e1s Gonz\u00e1lez L\u00f3pez<\/option><option value='Paula Valentina Delgado Romero' >Paula Valentina Delgado Romero<\/option><option value='Santiago Alejandro Romero Garc\u00eda' >Santiago Alejandro Romero Garc\u00eda<\/option><option value='Sergio Miguel Moreno Fern\u00e1ndez' >Sergio Miguel Moreno Fern\u00e1ndez<\/option><option value='Valentina Isabella Morales P\u00e9rez' >Valentina Isabella Morales P\u00e9rez<\/option><option value='Valeria Sof\u00eda Fern\u00e1ndez Garc\u00eda' >Valeria Sof\u00eda Fern\u00e1ndez Garc\u00eda<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_59_26'>Seleccione su nombre<\/div><\/div><div id=\"field_59_6\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_6\" ><label class='gfield_label gform-field-label' for='input_59_6'>Fecha del reporte<\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_6' id='input_59_6' type='text' value='16\/04\/2026' class='medium'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_59_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_7\" ><legend class='gfield_label gform-field-label' >Desea copia a Orientaci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_7'>\n\t\t\t<div class='gchoice gchoice_59_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='No'  id='choice_59_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_7_0' id='label_59_7_0' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='Si'  id='choice_59_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_7_1' id='label_59_7_1' class='gform-field-label gform-field-label--type-inline'>Si<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_8\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_8\" ><label class='gfield_label gform-field-label' for='input_59_8'>Correo del docente<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_8' id='input_59_8' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_59_9\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_9\" ><label class='gfield_label gform-field-label' for='input_59_9'>Estudiante<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_59_9' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><\/select><\/div><\/div><div id=\"field_59_10\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_10\" ><label class='gfield_label gform-field-label' for='input_59_10'>C\u00e9dula\/ID<\/label><div class='ginput_container ginput_container_text'><input readonly='readonly' name='input_10' id='input_59_10' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_11\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_11\" ><label class='gfield_label gform-field-label' for='input_59_11'>Grupo\/Secci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_11' id='input_59_11' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_12\" 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_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_12\" ><label class='gfield_label gform-field-label' for='input_59_12'>Fecha de la situaci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_12' id='input_59_12' type='text' value='' class='datepicker gform-datepicker dmy datepicker_no_icon gdatepicker-no-icon'   placeholder='dd\/mm\/aaaa' aria-describedby=\"input_59_12_date_format gfield_description_59_12\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_59_12_date_format' class='screen-reader-text'>DD barra MM barra AAAA<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_59_12' class='gform_hidden' value='https:\/\/crtecnica.com\/demoinstitucion\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_59_12'>Indique la fecha en que se di\u00f3 la situaci\u00f3n reportada<\/div><\/div><fieldset id=\"field_59_13\" class=\"gfield gfield--type-time gfield--input-type-time gfield--width-half gfield_contains_required field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_13\" ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Hora<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/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_59_13'>\n                            <input type='number' maxlength='2' name='input_13[]' id='input_59_13_1' value=''  min='0' max='12' step='1'  placeholder='HH' aria-required='true'   aria-describedby=\"gfield_description_59_13\"\/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_59_13_1'>Horas<\/label>\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                            <input type='number' maxlength='2' name='input_13[]' id='input_59_13_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_59_13_2'>Minutos<\/label>\n                        <\/div>\n                        <div class='gfield_time_ampm ginput_container ginput_container_time below gform-grid-col' >\n                                \n                                <select name='input_13[]' id='input_59_13_3'  >\n                                    <option value='am' >AM<\/option>\n                                    <option value='pm' >PM<\/option>\n                                <\/select> \n                                <label class='gform-field-label gform-field-label--type-sub am_pm_label screen-reader-text' for='input_59_13_3'>AM\/PM<\/label>                                \n                           <\/div>\n                    <\/div><div class='gfield_description' id='gfield_description_59_13'>Indique la hora del hecho<\/div><\/fieldset><div id=\"field_59_18\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_18\" ><label class='gfield_label gform-field-label' for='input_59_18'>Tipo de situaci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_59_18' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Seleccione uno' >Seleccione uno<\/option><option value='Situaci\u00f3n emocional de riesgo' >Situaci\u00f3n emocional de riesgo<\/option><option value='Emergencia M\u00e9dica' >Emergencia M\u00e9dica<\/option><option value='Acoso' >Acoso<\/option><option value='Intimidaci\u00f3n' >Intimidaci\u00f3n<\/option><option value='Bullying Cibern\u00e9tico' >Bullying Cibern\u00e9tico<\/option><option value='Comportamiento discriminatorio' >Comportamiento discriminatorio<\/option><option value='Violencia f\u00edsica' >Violencia f\u00edsica<\/option><option value='Violencia verbal' >Violencia verbal<\/option><option value='Comportamiento ofensivo' >Comportamiento ofensivo<\/option><option value='Da\u00f1o a la propiedad' >Da\u00f1o a la propiedad<\/option><option value='Abuso de sustancias' >Abuso de sustancias<\/option><option value='Otro (especificar):' >Otro (especificar):<\/option><\/select><\/div><\/div><div id=\"field_59_19\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_19\" ><label class='gfield_label gform-field-label' for='input_59_19'>Tipo (OTRO)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_19' id='input_59_19' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_14\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_14\" ><label class='gfield_label gform-field-label' for='input_59_14'>Descripci\u00f3n del incidente<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_14' id='input_59_14' class='textarea small'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_15\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_15\" ><label class='gfield_label gform-field-label' for='input_59_15'>Evidencia 1<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='5242880' \/><input name='input_15' id='input_59_15' type='file' class='large' aria-describedby=\"gfield_upload_rules_59_15\" onchange='javascript:gformValidateFileSize( this, 5242880 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_59_15'>Tipos de archivos aceptados: jpg, jpeg, png, Tama\u00f1o m\u00e1ximo de archivo: 5 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_59_15'><\/div><\/div><\/div><div id=\"field_59_16\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_16\" ><label class='gfield_label gform-field-label' for='input_59_16'>Evidencia 2<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='5242880' \/><input name='input_16' id='input_59_16' type='file' class='large' aria-describedby=\"gfield_upload_rules_59_16\" onchange='javascript:gformValidateFileSize( this, 5242880 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_59_16'>Tipos de archivos aceptados: jpg, jpeg, png, Tama\u00f1o m\u00e1ximo de archivo: 5 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_59_16'><\/div><\/div><\/div><fieldset id=\"field_59_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_27\" ><legend class='gfield_label gform-field-label' >Cantidad de testigos<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_27'>\n\t\t\t<div class='gchoice gchoice_59_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='0' checked='checked' id='choice_59_27_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_27_0' id='label_59_27_0' class='gform-field-label gform-field-label--type-inline'>0<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='1'  id='choice_59_27_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_27_1' id='label_59_27_1' class='gform-field-label gform-field-label--type-inline'>1<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_27_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='2'  id='choice_59_27_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_27_2' id='label_59_27_2' class='gform-field-label gform-field-label--type-inline'>2<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_27_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='3'  id='choice_59_27_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_27_3' id='label_59_27_3' class='gform-field-label gform-field-label--type-inline'>3<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_28\" ><label class='gfield_label gform-field-label' for='input_59_28'>Nombre: Testigo 1<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_59_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_29\" ><label class='gfield_label gform-field-label' for='input_59_29'>Funci\u00f3n\/Cargo (1)<\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_59_29' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_30\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_59_30\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo est\u00e1 oculto cuando se visualiza el formulario\"><\/i><span>Este campo est\u00e1 oculto cuando se visualiza el formulario<\/span><\/div><label class='gfield_label gform-field-label' for='input_59_30'>Firma1<\/label><div class='ginput_container ginput_container_text'><input name='input_30' id='input_59_30' type='text' value='___________________' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_31\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_31\" ><label class='gfield_label gform-field-label' for='input_59_31'>Nombre: Testigo 2<\/label><div class='ginput_container ginput_container_text'><input name='input_31' id='input_59_31' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_32\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_32\" ><label class='gfield_label gform-field-label' for='input_59_32'>Funci\u00f3n\/Cargo (2)<\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_59_32' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_33\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_59_33\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo est\u00e1 oculto cuando se visualiza el formulario\"><\/i><span>Este campo est\u00e1 oculto cuando se visualiza el formulario<\/span><\/div><label class='gfield_label gform-field-label' for='input_59_33'>Firma2<\/label><div class='ginput_container ginput_container_text'><input name='input_33' id='input_59_33' type='text' value='___________________' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_35\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_35\" ><label class='gfield_label gform-field-label' for='input_59_35'>Nombre: Testigo 3<\/label><div class='ginput_container ginput_container_text'><input name='input_35' id='input_59_35' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_34\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_34\" ><label class='gfield_label gform-field-label' for='input_59_34'>Funci\u00f3n\/Cargo (3)<\/label><div class='ginput_container ginput_container_text'><input name='input_34' id='input_59_34' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_36\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_59_36\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo est\u00e1 oculto cuando se visualiza el formulario\"><\/i><span>Este campo est\u00e1 oculto cuando se visualiza el formulario<\/span><\/div><label class='gfield_label gform-field-label' for='input_59_36'>Firma3<\/label><div class='ginput_container ginput_container_text'><input name='input_36' id='input_59_36' type='text' value='___________________' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_17\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  data-js-reload=\"field_59_17\" ><label class='gfield_label gform-field-label' for='input_59_17'>Accion tomada<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Obligatorio)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_17' id='input_59_17' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_22\" 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data-js-reload=\"field_59_37\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo est\u00e1 oculto cuando se visualiza el formulario\"><\/i><span>Este campo est\u00e1 oculto cuando se visualiza el formulario<\/span><\/div><label class='gfield_label gform-field-label' for='input_59_37'>Correo UPRE<\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_59_37' type='text' value='upre@gmoil.com' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_23\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\"  data-js-reload=\"field_59_23\" ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"Este campo est\u00e1 oculto cuando se visualiza el formulario\"><\/i><span>Este 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