Event Quotation Form
This form will allow us to provide you with a quotation for Event Medical Cover. Please ensure you fill out this form with as much detail and accuracy as possible. Providing false information will result in an automatic denial of services for your event.
Organiser Details
These should be the details of the person filling out this quotation form.
Name
*
First Name
Last Name
Organisation/Company Name:
*
If not applicable please put N/A
Please provide the best email address for contacting you:
*
example@example.com
Telephone Number
*
Event Details
Please be aware that you should allow 30 minutes before the start time of the event for our staff to arrive and set up our equipment. The same should be considered at the end of the event for our staff to pack up equipment where it is not being left on site.
Name of event:
*
Related Website:
*
Please input a website related to the event, if there is not one relevant, please input 'N/A'
Start Date of Event:
*
-
Day
-
Month
Year
Date
End Date of Event:
*
-
Day
-
Month
Year
Date
Medical Team Onsite Time:
*
Hour Minutes
AM
PM
AM/PM Option
Time Public expected to arrive at site:
*
Hour Minutes
AM
PM
AM/PM Option
Time Public expected to be offsite:
*
Hour Minutes
AM
PM
AM/PM Option
Medical Team Stand Down Time:
*
Hour Minutes
AM
PM
AM/PM Option
Address of Proposed Event:
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please provide a What3Words location for the event:
*
an example: words.three.what
Please provide a detailed explanation of your event:
*
Please include relevant details about your event including if it is a ticketed event or public access or if there will be alcohol on site.
Do you have a Risk Assessment in place for your event?
*
Yes
No
I need help doing this
If Yes to the above, please upload it here.
Browse Files
Drag and drop files here
Choose a file
Please upload your risk assessment here.
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Is there an Event Plan detailing the timings and activities planned for the day(s) of the event?
*
Yes
No
If Yes to the above, Please upload it here.
Browse Files
Drag and drop files here
Choose a file
Please upload your event plan here.
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of
Do you have appropriate insurance in place for this event?
*
Yes
No
Please upload your insurance documents
Browse Files
Drag and drop files here
Choose a file
This is so that we can hold a record of the appropriate insurance being held for the event. Failure to provide insurance documents may result in us cancelling your cover.
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Please provide details of the Site Contact on the date(s) of your event to include: Name, Role and Telephone Number
*
Will there be free parking on site for our staff?
*
Please Select
Yes
No
Will our team have access to free water/refreshments?
*
Please Select
Yes, Food and Drink
Yes, Food Only
Yes, Drink Only
No
Will there be access to toilet facilities?
*
Please Select
Yes, separated from the public
Yes, shared with the public
No
Will our team have access to electricity?
*
Please Select
Yes
No
Will our team have a private sheltered/indoor/outdoor tented area to assess and treat patients?
*
Please Select
Yes, indoor
Yes, outdoor
No, Medical Centre Gazebo required
Please describe the area we will be using to treat patients if you are providing one:
*
If you are not providing an area for our team to treat patients, please detail where we can set up our medical tent.
Please provide details of any other organisation(s) involved in the provision of medical care/first aid at this event. Please ensure you include their contact details.
*
If there is an organisation(s) other than us providing cover to the event, please also detail who will be the lead agency for the cover provided.
Cover Requirements
Will the General Public be on site?
*
Yes
No
Number of people expected on site (including spectators and staff) at any one time
*
If the event runs over multiple days, please input the maximum number of people expected on site at any one time.
Select make up of crowd
*
Please Select
Full mix, in family groups
Full mix, not in family groups
Predominantly Older persons
Predominantly young adults
Predominantly Children & Teenagers
Full mix, Rival Factions
Please ensure you answer this honestly. Providing false information may cause us to refuse to cover your event.
Will any of the following activities be taking place at the event site?
*
Street Carnival
Street Theatre
Fireworks
Climbing
Abseiling
Motorised Water Sports
Helicopters
Model Flying Display
Parachute Display
Contact Sports
Quad Bikes
Other Motor Sports
Licensed Bar
Other
None
If you ticked 'Other' Please provide details here
*
If you ticked 'None' please enter 'N/A'.
Name and Address of the nearest A&E department
*
Has this event taken place before? If so please explain the previous level of medical cover, any issues encountered and any common injuries including numbers of people seeking medical assistance at the event.
*
If this event has never run before please provide as much detail as possible; We understand you may not be able to provide numbers in this case.
What level of medical cover do you require? Do not worry if you are unsure, we can help you with this.
*
Are the local Safety Advisory Group (SAG) aware of this event?
*
Yes
No
Not Applicable
Do you require us to provide a representative at a SAG meeting?*
*
Yes
No
Not Applicable
Is there a SAG meeting set up? If so, please provide Date, Time, Location and any meeting notes here
*
Do you expect to require any of the following (Including our staff)
*
Ambulance that is able to convey to hospital
Additional Medical Tent/Treatment Point
Off road, Stretcher carrying 4 x 4
Paramedic
Doctor
Specialist personnel and equipment
None Required
If you ticked 'Specialist Personnel and equipment', Please tell us what kind of specialist personnel and equipment you need?
*
If you ticked none required, please enter 'N/A' into this box
Any other information that you think we may find useful?
*
*Please Note
If you require us to attend a SAG meeting for this event, please ensure you give us a minimum of 7 working days notice. Please also be aware that there will be a surcharge of £50
Billing Details
We will send a no obligation quote for medical cover for this event to you, using the details you provide below. This is so we know who is responsible for payment should you accept the quotation.
Name
*
First Name
Last Name
Billing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Billing telephone number
*
Please enter a valid phone number.
Email address for the Invoice to be sent
*
example@example.com, this is so an invoice can be sent to the responsible person for payment should you accept our quotation.
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