Sheet 1: Rooms requested

	
	
	
	
	

		

 
		
		
School of Medicine
		


		
NOTES
	
	

		
All requests for room bookings in SAFB for student-led activities in School of Medicine space must complete this document. 
All questions must be answered. Some answer boxes have drop-down pick lists, others are free text.
		


		
*  Alongside this proforma, some information starred below must also be supplied to ICU through their room booking system in order that a planned event can be assessed by College and allowed to take place. ICU  may also require other information. 
	
	

		


		


		


		


	
	

		
EVENT
		


		


		


	
	

		
Name of Club/Society organising event
		


		


		
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State if Club/Society is College SU or ICSMSU 
		


		


		
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Name of Event
		


		


		
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Invited Speakers - List names and addresses (incl emails) of each
		


		


		
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Title of each Talk
		


		


		
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Responsible person 1 for Event & College email
		


		


		
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Responsible person 2 for Event & College email
		


		


		
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Please note that Security may need to provide extra Building Security during the event. 
This may incur additional charges which the Event organisers will be required to pay.
		


		


	
	

		
DATE and TIME
		


		


		


	
	

		
Date for start of Event
		


		


		


	
	

		
Date for end of Event
		


		


		


	
	

		
Start time day 1
		


		


		


	
	

		
End time day 1
		


		


		


	
	

		
Start time day 2
		


		


		


	
	

		
End time day 2
		


		


		


	
	

		
Is event longer than 2 days
		


		


		


	
	

		


		


		


		


	
	

		
INTENDED AUDIENCE
		


		


		


	
	

		
Anticipated number of attendees
		


		


		
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Attendees include non-College members
		


		


		
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Will include under the age of 18
		


		


		
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ROOMS REQUESTED
		


		


		


	
	

		
Room 1
		


		


		


	
	

		
Room 2
		


		


		


	
	

		
Room 3
		


		


		


	
	

		
Room 4
		


		


		


	
	

		
Room 5
		


		


		


	
	

		
Room 6
		


		


		


	
	

		
Room 7
		


		


		


	
	

		
Room 8
		


		


		


	
	

		
Room 9
		


		


		


	
	

		
Room 10
		


		


		


	
	

		
Room 11
		


		


		


	
	

		
Room 12
		


		


		


	
	

		
Room 13
		


		


		


	
	

		
Room 14
		


		


		


	
	

		
Room 15
		


		


		


	
	

		


		


		


		


	
	

		
ACTIVITIES
Provide brief description of each activity 
in the cells in Column B
		
1
		


		


	
	

		
2
		


		


	
	

		
3
		


		


	
	

		
4
		


		


	
	

		
5
		


		


	
	

		
6
		


		


	
	

		
7
		


		


	
	

		
8
		


		


	
	

		
9
		


		


	
	

		
10
		


		


	
	

		


		


		


		


	
	

		
RISKS
		
Answer all questions in cells below
some require selection from a  pick list
		


		


	
	

		
Will biological material be used
		


		


		


	
	

		
Details of the biological material
		


		


		


	
	

		
Will chemicals be used
		


		


		


	
	

		
List all chemicals to be used
		


		


		


	
	

		
Sharps (e.g. scissors, scalpels and needles) to be used
		


		


		


	
	

		
Persons connected electrically to equipment
		


		


		


	
	

		
Type of equipment that subjects will  be connected to
		


		


		


	
	

		
Requires furniture, poster boards or equipment relocated
		


		


		


	
	

		
Specify what and to where items are to be moved
		


		


		


	
	

		


		


		


		


	
	

		
EQUIPMENT
		


		


		


	
	

		
What PPE will be required?
(to be supplied by the event organisers)
		
Delete where not applicable 
Lab coat/Apron/Gloves/Face Shield/Goggle/Specify any other
		


		


	
	

		
Equipment request for borrowing from 
Learning Resources - list all and quantity
		


		


		


	
	

		
Equipment to be brought from elsewhere 
- list all and owners of each
		


		


		


	
	

		


		


		


		


	
	

		
WASTE DISPOSAL and CLEANUP
		


		


		


	
	

		
Orange bags required
		


		


		


	
	

		
Sharps bins required
		


		


		


	
	

		
Medical meat disposal is arranged via the supplier
		


		


		


	
	

		
Bulk biological waste disposal necessary
		


		


		


	
	

		
Cleanup/disinfection arrangements needed - details to be specified in risk assessment
		


		


		


	
	

		


		


		


		


	
	

		
PROTOCOLS FOR THE EVENT
		


		


		


	
	

		
Describe each lab-based process to the participants and include how materials, chemicals and equipment are to be used
		


		


		


	
	

		
Describe how spillages are to be dealt with
		


		


		


	
	

		
Describe what to do in the event of an accident and availability of First Aid
		


		


		


	
	

		


		
Depending on the answers to all the questions above, a detailed  formal Risk Assessment for the activities proposed may be required, along with copy of instructions to be issued to those attending the activity. 
In the absence of an acceptable risk assessment, the event booking will be liable for cancellation. 
Allow sufficient time before the event to undertake this assessment in case queries are raised and amendments are necessary
		


		


	
	

		
RISK ASSESSMENT submitted