Event Medical Cover
You may use the following form to send us details of your event, we will then assess the risk as per the Purple and Green guides and advise you on the level of cover required
Please answer all questions as fully as possible. If your type of event is not listed please choose the closest match and add details in the last section.
Invoice / Contact Information
Organisation
City
Email
Name
County
Address
Payment Type
Please Select
Cash on day
Cheque on day
Invoice
Credit Card (+3.5%)
Post Code
Street
Phone
Event Logistics Information
Contact on Day
Contact Number
Name of Event
Summer / Winter
Spring / Autumn
Type of Event
Please Select
Agriculrtial/County Show
Classical Concert
State Occasion
Marine Event
Sports Event
Public Exhibition
Motorcycle Display
Aviation
Music Festival
Family Fun Day
VIP Visit / Summit
Motor Sport - Racing
Bonfire/Fireworks/pyrotechnics
Rock / Pop Event
Possible Public Disorder - Medium
New Year Celebration
Possible Public Disorder - High
Dance Event
Public Demonstration - Opposing Sides
Number of Sites
Type of Venue
Finish Day*
Please Select
Indoors
Outdoors Small Area
Stadium
Outdoors Wide Area
Town Centre / Streets
Tents / Marquees
Overnight Camping
Date of event
*Leave blank if same day
Address of Venue
Finish Time
Start Time
Are there any additional side events? Carnival, Helecopter Rides, Street Theatre etc. Please list all here
Audience Information
Type of Audience
Addience Position
Please Select
Seated all the time
Seated and Standing
Standing most of time
Please Select
Wide Range of Age Family Groups
Wide Range of Age not Family
Young Adults 18-24
Mostly Children or Elderly
Wide Range of Rival Groups
Numbers Expected
Time expected queing
Please Select
Less than 4 hours
More than 4 hours
More than 12 hours
Please Select
Up to 1000
Up to 3000
Up to 5000
Up to 10 000
Up to 20 000
Up to 30 000
Up to 40 000
Up to 60 000
Up to 80 000
Up to 100 000
Up to 200 000
Up to 300 000
Event Information
Yes
No
Have we covered this event before?
Number of Casualties at last event
Please Select
Less than 1%
Medium Rate 1-2%
High Rate over 2%
First Year of Event
Please Select
Small
Large
Type of A & E
Please Select
Less than 30 mins by road
More than 30 mins by road
How close is the nearest A&E?
What accomodation is available for Medical Treatment?
Please put details here
Yes
No
Is Electric Available?
Are there any safety or club rules to comply with? (Eg Safety wear)
Please put details here
Are there refreshments on site?
Does insurance require Medical Cover?
Is there a Doctor on site?
Are there Toilets on site?
Yes
No
Yes
No
No
Yes
No
Yes
How should we contact them?
Is there any other information we should know?
Please put details here
Risk Score
I Agree to the Terms and Conditions
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