The Form input elements are:
Reporter name text type input
Password password type input element
Description of the incident textarea element
Category for incident menu
Checkbox to request email report copy checkbox
Optional email address if requested text type input
No inputs for time, date, or incident number,
Lay out the form in a visually effective way using HTML elements and style rules to control the appearance of the elements including the font-family, font-size, background colors, and text color.
All the elements mentioned must belong to (one) form - not multiple forms - since only one form can be transmitted at a time (that is, triggered or fired by a form submit).