Event Cover Request
To enquire about event medical cover, please complete the simple Event Cover Request (below). Once
we have received your information, we will carry out a risk assessment and quote you for the level of cover we
recommend - your request/requirements will be graded against the Purple Guide.
Any fields highlighted with ** are mandatory.
Contact Details
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| ** Name: |
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| Company: |
|
| ** Telephone: |
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| ** E-mail Address: |
|
Event Details
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| ** Event Start Date: |
on
|
| ** Event Finish Date: |
on
|
| ** Event (Name): |
|
| ** Event Description: |
|
| ** Event Address: |
|
Participant Details
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| Expected Number of Participants: |
|
| Age Range of Participants: |
to
|
Operation Details
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| No. of Ambulances Required: |
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| No. of First Aiders Required: |
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| No. of Nurses Required: |
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| No. of Paramedics Required: |
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| No. of Technicians Required: |
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| Required Start Time: |
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| Required Finish Time: |
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Additional Notes
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| Notes: |
|
|