EVENT REQUEST
Today's Date
*
/
Day
/
Month
Year
Date
YOUR NAME
*
COMPANY NAME
*
YOUR POSITION
*
YOUR EMAIL
*
PHONE NUMBER
*
EVENT NAME
*
EVENT TYPE
*
EVENT LOCATION
*
Full street address, suburb and postcode
EVENT START
*
-
Day
-
Month
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
EVENT END
*
-
Day
-
Month
Year
Date
1
2
3
4
5
6
7
8
9
10
11
12
:
Hour
00
10
20
30
40
50
Minutes
AM
PM
AM/PM Option
TOTAL PARTICIPANTS
*
TOTAL MALE >18
*
TOTAL PARTICIPANTS >18
*
TOTAL MALE
*
TOTAL FEMALE
*
TOTAL SPECTATORS + MEDIA
*
WEATHER VARIABLES
*
YES
NO
UNSURE
Will the event proceed rain, hail or shine?
RELEVANT EVENT HISTORY
*
YES
NO
UNSURE
if YES add details in COMMENTS section
OTHER MEDICAL SERVICES INVOLVED
*
YES
NO
UNSURE
if YES add details in COMMENTS section
ANY SPECIAL EQUIPMENT INVOLVED?
*
YES
NO
UNSURE
if YES add details in COMMENTS section
ANY ANIMALS INVOLVED?
*
YES
NO
UNSURE
if YES add details in COMMENTS section
ANY PYROTECHNICS or LIGHT HAZARDS?
*
YES
NO
UNSURE
if YES add details in COMMENTS section
ANY NOISE HAZARDS?
*
YES
NO
UNSURE
if YES add details in COMMENTS section
HAS A RISK ANALYSIS BEEN COMPLETED
*
YES
NO
UNSURE
if YES please ATTACH below
ADDITIONAL RISK REDUCTION MEASURES IN PLACE
*
Please list if applicable or write NONE
PAYMENT WILL BE MADE IN ADVANCED OR GUARANTEED BY?
*
This section MUST be completed
HOW DID YOU HERE ABOUT US?
*
Please list if applicable or write NONE
ATTACHMENTS
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