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
Post Code
Street
Phone
Event Logistics Information
Contact on Day
Contact Number
Name of Event
Summer / Winter
Spring / Autumn
Type of Event
Number of Sites
Type of Venue
Finish Day*
Click here to open the date picker
Click here to open the date picker
Date of event
*Leave blank if same day
Address of Venue
Finish Time
Start Time
Are there any additional side events? Carnival, Helicopter Rides, Street Theatre etc. Please list all here
Audience Information
Type of Audience
Audience Position
Numbers Expected
Time expected queuing
Event Information
Yes
No
Have we covered this event before?
Number of Casualties at last event
Type of A & E
How close is the nearest A&E?
What accommodation is available for Medical Treatment?
Yes
No
Is Electric Available?
Are there any safety or club rules to comply with? (Eg Safety wear)
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?
Risk Score
I Agree to the Terms and Conditions