Request Medical Cover Posted June 15, 2015 by Jason Foster Medical Cover Request Form Request medical cover for your event.Step 1 of 425%Name of Event*Event Date* Booking Contact* First Last Person responsible for making the bookingBooking Phone No*Billing Address* Street Address Address Line 2 City ZIP / Postal Code Email* We will use this address for billing. Date of Event* First date of eventNumber of days needing cover*Total number of day you require IAS to be on siteLocation / Address of Venue* Street Address Address Line 2 City ZIP / Postal Code Ikon arrival time* : HH MMEvent Start Time* : HH MMEvent Finish Time* : HH MMIkon Leaving Time* : HH MMOn most occasions over runs can be accommodated. However we do use this time to plan resource management so some elements of your cover may leave site after this time.Duration of cover*Total number of cover hours On site Contact DetailsEvent contact*Primary contact at the event.On site Contact Number*Planned Activities (Please Describe)*Expected number of public attending site at any one time?*Expected number of participants attending at any one time?* Risk Assessments and liabilitiesPlease provide information on previous casualties at your event, if any.*Other hazards we should be aware of? Please be as specific as possible.*Other hazards include fireworks, aircraft etc.Purple Guide Risk AssessmentThe result of a purple guide risk assessment, is a helpful guide. It will provide the foundation of the event specific risk assessment and management plan. It will evidence a basic HSE recognised assessment has taken place. Copy and paste this link for the medical guidance and risk assessment tool. http://www.eventmedicalcover.com/purple-guide/I don't need a Purple Guide Risk Assessment I don't need a purple guide assessment, I have our own risk assessmentEvent/Site risk assessment* Drop files here or Please upload your event risk assessment and insurance details.Event schedule/programme and site maps Drop files here or Please upload any useful documentation in relation to your event.Please provide any details of your insurances stipulations, if any.*Resources required. Ambulances, treatment units etc*ParamedicsN/AOneTwoThreeFourFiveSixSevenEightNineTenElevenTwelve +Number of paramedics requiredEmergency Medical TechniciansN/AOneTwoThreeFourFiveSixSevenEightNineTenElevenTwelve +Number of EMTs requiredEvent first responders/Advanced first aidersN/AOneTwoThreeFourFiveSixSevenEightNineTenElevenTwelve +Number of EFR/AFA requiredFirst AidersN/AOneTwoThreeFourFiveSixSevenEightNineTenElevenTwelve +Number of first aiders requiredNotesTwo week confirmation* I take responsibility to keep IAS updated and will make contact 14 days prior to my event.Please confirm you will make contact with Ikon Ambulance Services two weeks (14 days) before your event to confirm the event is still going ahead and up date us to any changes. We may not be able to accommodate changes if notice is less than 14 days?.