E-mail Address: *
Name *
Company Name
Phone/Mobile Number *
Your address
Date of event *
Start time *
End time *
Nature of Event *
Public Exhibition ( 3 )
Pop/Rock Concert ( 5 )
Dance Event ( 8 )
Agricultural/Country Show ( 2 )
Marine ( 3 )
Motorcycle Display ( 3 )
Avaition ( 3 )
Motor Sport ( 4 )
State Occasions ( 2 )
VIP Visits/Summit ( 2 )
Music Festival ( 3 )
Bonfire/Pyrotechnic Display ( 4 )
New Year Celebrations ( 7 )
Classical Preformance ( 2 )
Demonstrations/Marches/Politcal events *
Medium risk of disorder (5 )
High risk of disorder ( 7 )
Opposing fractions involved ( 9 )
Low risk of disorder ( 2 )
Venue *
Stadium ( 2 )
Outdoor in confined location e.g Park ( 2 )
Other Outdoor e.g Festival ( 3 )
Widespread public location in streets ( 4 )
Temporary outdoor structures ( 4 )
Includes overnight camping ( 5 )
Indoor ( 1 )
Standing/Seated *
Mixed ( 2 )
Standing ( 3 )
Seated ( 1 )
Audience Profile *
Full mix not in family groups ( 3 )
Prodiminately young adults ( 3 )
Prodiminately children and teenagers ( 4 )
Prodiminately elderly ( 4 )
Full mix rival fractions ( 5 )
Full mix in family groups ( 2 )
Past History *
Good data, low casualty rate previously ( -1 )
Good data, medium casualty rate previously ( 1 )
Good data, high casualty rate previously ( 2
First event, no data ( 3 )
Expected Numbers *
1000 ( 1 )
3000 ( 2 )
5000 (8 )
10 000 ( 12 )
20 000 ( 16 )
30 000 ( 20 )
40 000 ( 24 )
60 000 ( 28 )
80 000 ( 34 )
100 000 ( 42 )
200 000 ( 50 )
300 000 ( 58 )
Expected Queuing *
Less than 4 hours ( 1 )
More than 4 hours ( 2 )
More than 12 hours ( 3 )
Time of Year ( outdoor events ) *
Summer ( 2 )
Autumn ( 1 )
Winter ( 2 )
Spring ( 1 )
Proximity of definitive care (nearest suitable A&E facility ) *
Less than 30 min by road ( 0 )
More than 30 min by road ( 2 )
Profile of definitive care *
Choice of A&E departments ( 1 )
Large A&E department ( 2 )
Small A&E department ( 3 )
Additional on-site facilities *
Suturing ( -2 )
X-ray ( -2 )
Minor surgery ( -2 )
Plastering ( -2 )
Psychiatric / GP facilities ( -2 )
Additional Hazzards *
Carnival ( 1 )
Helicopters ( 1 )
Motor sport ( 1 )
Parachute display ( 1 )
Street theatre ( 1 )
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