The Following form is for guidance only, and event managers are advised to complete an independent assessment. The Risk assessment has been based on the industry recongnised formula, provided by the Health and Safety Executive - The Event Safety Guide. HMSO. By using the form below you may obtain an estimated risk assessment total which will give an indication as to the level of cover required. Choose the options which best matches you event from each of the following sections. Section 1 - Your Information Please complete All the fields within this section as we will need the information to contact you if needed for further information and to send you a risk assessment review and quotation. Your Name (required) Your Organisation Name (required) Your Email (required) Landline Number (required) Address and Postcode (required) Event Date and Times (required) Insert Date: Time: 1.002.003.004.005.006.007.008.009.0010.0011.0012.0013.0014.0015.0016.0017.0018.0019.0020.0021.0022.0023.0024.00 to 1.002.003.004.005.006.007.008.009.0010.0011.0012.0013.0014.0015.0016.0017.0018.0019.0020.0021.0022.0023.0024.00 Section 2 - Risk Assessment Please answer all of the questions below. You can select multiple answers by holding down the "CNTL" Key and clicking on all the answers within the section. If you are not sure or require further information regarding any of the questions below, please contact us Type of Event ---Sports Event Track and FieldEquestrian EventBoxing/Martial ArtsClassical PerformancePublic ExhibitionPop/Rock ConcertDance EventAgricultural/County ShowMarineMotorcycle DisplayAviationMotor SportState OccasionsVIP visits/summitsMusic FestivalBonfire/Pyrotechnic displayNew Year Celebration Venue/Location of Event ---IndoorStadiumOutdoor in Confined locationOther Outdoor (eg, Festival)Widespread public location in streetsTemporary Outdoor StructureIncludes overnight camping Standing/Seated ---SeatedMixedStanding Audience Profile ---Full Mix, in family groupsFull Mix, not in family groupsPredominately young AdultsPredominately children and TeenagersPredominately Elderly Past History ---Good data, low casualty rate previously (less than 1%)Good date medium casualty rate previously (1%-2%)Good date - high casualty rate previously (more than 2%)First event - No Date Expected Numbers ---less than 1000less than 3000less than 5000less than 10,000less than 20,000less than 30,000less than 40,000less than 60,000less than 80,000less than 100,000less than 200,000less than 300,000 Expected Queuing ---less than four hoursMore than four hoursmore than twelve hours Time of Year ---SummerAutumnWinterSpring Proximity to definitive care (A&E) ---Less than 30 minutes by RoadMore than 30 minutes by Road Profile of definitive care ---Choice of A & E departmentsLarge A & E DepartmentSmall A & E Department Additional Hazard's ---NoneCarnivalHelicoptersMotor SportsParachute DisplaysStreet Theatre Section 3 - Additional Information Please let us know any other information which can support your risk assessment which can include other measures for example (for example if you are holding a fireworks display which a registered fireworks company has been contracted to carry out and will submit their own risk assessment, please let us know here.) Section 4 - Next steps Using the information that you have supplied, Ice Blue Medical will e-mail you a quotation and review your assessment within the next five working days. We may need to contact you for further information. Please note that this form does NOT confirm a booking and does NOT confirm a contract to provide support at your event.