E-mail Address: * Name: * Company Name: Phone/Mobile Number: * Address: * Date Of Event: * Start Time: * End Time: * Nature of Event: * Please pick an answer below 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 ) Public Exhibition ( 3 ) 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: * Please pick an answer below Psychiatric / GP facilities ( -2 ) Plastering ( -2 ) Minor surgery ( -2 ) X-ray ( -2 ) Suturing ( -2 ) None Additional Hazards: * Please pick an answer below Carnival ( 1 ) Helicopters ( 1 ) Motor sport ( 1 ) Parachute display ( 1 ) Street theatre ( 1 ) None Please provide any additional information here:
* Required