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
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
Name of event:
*
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
Will there be free parking on site for our staff?
*
Please Select
Yes
No
Please provide a detailed explanation of your event:
*
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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of
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.
Cancel
of
Will our team have access to water/refreshments?
*
Please Select
Yes
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
No
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.
Cover Requirements
Number of people expected on site (including spectators and staff)
*
If the event runs over multiple days, please input the maximum number of people expected on site at any one time.
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?
*
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 days notice. Please also be aware that there will be a surcharge of £50
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