Moving data from a columnar table to a record based table

Not sure that's a great title, but it's the best I could come up with right now.  I created the below table for ease of end-user data entry.  (To increase adoption rate and reduce pushback.)

I would like to create fields/or a table, that would basically take the column headers and the associated numbers into the more useful table that has a multiple choice field for offense type, the date and # in the column.  I believe this is very doable, but I am just drawing a blank tonight.