Event Information Questionnaire

Dear Organiser

Thank you for contacting the Northern Ireland Ambulance Service HSC Trust about your proposed event.

We would be grateful if you could take a few minutes to complete and submit the online questionnaire.

If required, this information may be shared with appropriate Northern Ireland Ambulance Service staff as it is extremely useful in assisting us in planning operational activity on the day and considering the potential local impact of your event. All information provided is processed in line with the Data Protection Act 1998.

Please note that the Northern Ireland Ambulance Service HSC Trust can only act on the information provided by you and cannot accept any liabilities in relation to errors or omissions.
Please tick to Agree*
- Please tick to confirm that you have read the information above and agree and to proceed to complete and submit Event Information Questionnaire.

Emergency Contact Details
Please provide the name and contact details for personnel who will be in attendance at the event.
Event Manager or Nominated Deputy
Event Manager or Nominated Deputy Name*
This is the name of the person from the event organiser who has responsibility for the medical cover and WHO WILL BE IN ATTENDANCE AT THE EVENT. Please insert the name of the Event Manager or their nominated deputy.
First Last
Phone*
Email
Risk Assesment
Please upload a copy of any event plans/ medical risk assessments.
Max. file size: 20 MB.
Medical Provider or Nominated Deputy
Medical Provider or Nominated Deputy Name*
This is the name of the person from the lead person from the Medical Provider organisation WHO WILL BE IN ATTENDANCE AT THE EVENT. Please insert the name of the Medical Provider or their nominated deputy.
First Last
Phone*
Email
Please note that if this information is not available at the time of notifying NIAS of your event, please provide this information to events@nias.hscni.net at the earliest possible opportunity. The Northern Ireland Ambulance Service HSC Trust can only act on the information provided by you and cannot accept any liabilities in relation to errors or omissions.
Please return to page 1, read the statement and tick to agree to continue.
Name
This field is for validation purposes and should be left unchanged.