Quote Request & Booking Form - Workforce Personnel

Quote Request & Booking Form - Workforce Personnel
Contact Details
Your Name*

First NameLast Name
Invoicing Organisation*
E.g. 'Bondi Community Events Association Ltd'
Industry*
Healthcare Category
Sports Category
Education Category
Government Category
Entertainment Category
Tourism/Hospitality Category
Corporate Category
Industrial Category
Transport/Warehousing
Phone Number (Business Hours)*
Please do not include any spaces
Email*
example@example.com
How did you hear about us?*

Return ClientGoogleSaw Us On DutyReferral - ColleagueReferral - FriendOther First Aid / Medical ProviderFacebookInstagramLinkedinGumtreeAdvertising or SponsorshipDepartment of Health (VIC) WebsiteOther
Event / Shift Details
Event Name*
Booking Type*

Ad-Hoc - yearlyAd-Hoc - once offContract - ongoing
Event / Shift Type*
Please note: if your event/requirement is higher risk which includes equestrian, motorsport, high impact or music event, we recommend allocating at least one (1) Registered Paramedic with advanced medications.
Event Type - REMOVED*

Sporting / Participation Event (Low Risk)Sporting Event (High Risk)Community EventExhibition / Corporate EventMusic EventSpectator EventParty / Celebration Event
Event Date*

DayMonthYear
Shift Start Time*

:HourMinutes
Shift End Time*

:HourMinutes
Additional Dates & Times
Venue Name*
Street Address
Street address for the event venue, please include the street number and street name
Suburb or Town*
Postcode*
State or Territory*

VICNSWQLDSATASWAACTNT
Level of Personnel Required*
Number of Personnel Requested*
Catering for Medics*

Provided Free of ChargeAvailable for PurchaseNo Food Onsite
Does your venue have an accessible and operational-ready Automated External Defibrillator (AED)?*

YesNo / Unsure / Colmed to supply
Location of AED:*
Please provide details of where the AED is located and confirm that it is accessible.
Equipment Required (subject to availability)*

No Additional Equipment RequiredRecommendation PreferredPortable Oxygen Therapy UnitAutomated External Defibrillator (AED)First Aid Station IdentifierPatient Monitoring EquipmentEvent VehicleResponse Vehicle 4WDStretcher VehicleStretcher Vehicle 4WDBicycle Response Crew (Team of 2)Spinal Immobilisation EquipmentILS Medications KitWheelchairALS Medications KitMarquee (3m x 3m) with 2 chairs and 1 table2 Chairs and 1 TableRescue TubeSports Trainer Taping KitMassage Table>2000pax - Low Risk Event Packing List2000-5000pax - Medium Risk Music Event Packing ListEvent Specific Packing ListILS High Risk Packing ListILS High Risk Packing List (Trauma - MotoX, Cycling, Equestrian)
Risk Information
Crowd Size*
Age of Patrons*

>65 / 0-1212-1616-3030-65 inc. familyAll Ages
Alcohol Availability*

NoneRestrictedReadily availableNo control or BYO
Probability of Illicit Substance Use*

NonePossibleProbableHighly Probable
Probability of High Impact Trauma*

NonePossibleProbableHighly Probable
Distance from Ambulance or Hospital*

< 10 kms10 - 50 kms50 - 100 kms> 100 kms
Other Risks
Please advise of any other associated risks.
Is your event likely to have any of the following risks? - REMOVED

High speed motorsport*Equestrian or horse related activities*Activities likely to result in major trauma*Event focused on contemporary music such as music festival, concert, party or nightclubVenue is in remote, rural or isolated location away from major health servicesProbable illicit substance use*Other
Venue Information
Site Contact*

First NameLast Name
Site Contact Mobile Phone*
Parking Availability for Colmed Personnel Vehicle*

Onsite Parking next to First Aid PostDedicated / Reserved Parking (Free)Public Car Park (Free)Street Parking (Free)Public Car Park - User PaysStreet Parking - User PaysNo parking availableOther
Parking Location at Venue
This if for our staff personal cars (ie. Toyota Yaris)
Meeting Location at Venue
Facilities Available at Venue for Colmed Use*

No Facilities Available OnsiteDedicated Private RoomEstablished First Aid RoomOther Shelter (eg Marquee or Tent)Access to Drinking WaterAutomated External Defibrillator (AED)Ice Machine / Ice in FreezerTwo Way RadiosChairs and TableWheelchairOther
Additional Notes for Personnel
I agree to the Colmed Group Terms & Conditions including privacy policy. (https://colmedgroup.com/terms-conditions)*

Yes
Should be Empty:

Quote Request & Booking Form - Workforce Personnel

Contact Details

Event / Shift Details

Risk Information

Venue Information