Demands and Needs Quotation Questionnaire (2016 Version) Thank you for giving Northern Independent Medical Services Limited the chance to quote for your event, to make sure you have the right cover we run our events through the HSG195 matrix. We base our quotes on the recommendations of that document from the HSE. If you have your own list of specific services you need please complete the form regardless and add a message in the comments box towards the end. The questionnaire is below, please complete it and attach it to an email, please send it back to office@nims-firstaid.co.uk if you would rather talk this over on the phone please call us on 07816 992 405. Either way this is the first step to securing the best medical cover for your event – keeping your customers and staff safe. 1) Tell us about the nature of your event, select one of the options below. ? Classical Performance ? Public Exhibition ? Pop/Rock Concert ? Dance/Rave Event ? Agricultural / County Show ? Marine (Water) ? Motorcycle Event ? Aviation Event ? State Occasion ? VIP Visit / Summit ? Music Festival ? Bonfire Display ? Pyrotechnic Display ? New Year’s Celebration ? Classical Performance ? Demo / Political ? Sporting Event ? Other (Specify) ...................................... 2) Which option best describes the venue? Select the applicable options. ? Indoor ? Stadium ? Outdoor (Confined Location e.g. a Park) ? Outdoor (Other e.g. Festival) ? Widespread location in a public street ? Temporary Outdoor Structures ? Overnight Camping ? Other (Specify) ...................................... 3) Will the people at your event be Standing, Seated or both? 4) Select the option below which best describes the audience profile you are expecting. ? Full Mix, in Family Groups ? Full Mix, not in Family Groups ? Predominately Young Adults ? Predominately Children/Teens ? Predominately Elderly People 5) Past History – Which option describes the events history the best? ? Good Data with a low casualty rate previously (less than 1%) ? Good Data with a medium casualty rate previously (1%-2%) ? Good Data with a high casualty rate previously (more than 2%) ? First event, no data. 6) How many people (crowds) are you expecting? Please round up to the nearest thousand. ? 7) Are you expecting queuing on entry? If so what times are crowds likely to wait…. ? Less than 4 hours ? More than 4 hours ? More than 4 hours 8) What is the date of your event (if you aren’t decided on the date yet please note a season) 9) What is the event address? (we use this to calculate the nearest Accident & Emergency Departments – please include a post code) 10) Will the event contain any of the following addition hazards? ? Carnival ? Helicopters ? Motor Sport ? Parachutes ? Street Theatre 11) Will the site have any of the following additional facilities? (Most Events don’t) ? Suturing ? X-Ray ? Minor Surgery ? Plastering ? GP / Psychiatric 12) Free text and additional comments and information Please add anything else that hasn’t been covered in the questions above – please be as honest as possible, crews on arrival may refuse jobs if the information provided isn’t accurate. – We just need to be prepared for everything. Your Name: …………………………………………. Your Contact No. ……………………………….. Your Email: …………………………………………. Your position ……………………………………... PLEASE SAVE THIS FORM AND EMAIL IT AS AN ATTACHMENT TO office@nims-firstaid.co.uk