Safety Service Request form For MSERT, Walksafe and Drivesafe

Event Name *

Event Date *

Event Start Time *

Event End Time *

Department/Group/Organization *

Coordinator (1) Name *

First

Last

Coordinator (1) Email *

Coordinator (1) Phone *

Coordinator (2) Name *

First

Last

Coordinator (2) Email *

Coordinator (2) Phone *

Location Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please include venue name, civic address, and postal code.

Type of Event *

Please provide a brief description of the nature of the event.

Expected Event Population *

Please provide estimation of the amount of people expected to attend.

Will Alcohol Be Served *

Yes
No

Services Requested *

Walksafe
Drivesafe
MSERT

All of the above services REQUIRE TWO WEEKS NOTICE PRIOR TO THE EVENT DATE. MSERT requires 2-3 WEEKS NOTICE prior to the event date, with the exact deadline depending on your event date. Specific deadlines can be found on the MSERT website -> Contact -> Request MSERT subsection. For MSERT , please note that taxi reimbursement will be requested after the event. You should hear back from MSERT and Walksafe within 2 business days. For Drivesafe, Drivesafe representative will reach out to you within 5 business days.

Meeting Location at Start of Event *

Please provide us the location of a meeting place prior to the event. (ex. landmark, front door, coat check, etc.)

Number of MSERT Responders Requested *

Will Red Frogs be present at your event? *

Yes
No

Number of Vans/Sedans Requested *

Would you like the vans to be present at: *

the same time
each at different times

Please advise the desired start time for the vans: *

Please advise the desired end time for the vans: *

Important note: The maximum duration is 4 hours! Also, end time can be no later than 3:30 AM!

Please advise the desired start time for van # 1: *

Please advise the desired end time for van # 1: *

Important note: The maximum duration is 4 hours! Also, end time can be no later than 3:30 AM!

Please advise the desired start time for van # 2: *

Please advise the desired end time for van # 2: *

Important note: The maximum duration is 4 hours! Also, end time can be no later than 3:30 AM!

Please advise the desired start time for van # 3: *

Please advise the desired end time for van # 3: *

Important note: The maximum duration is 4 hours! Also, end time can be no later than 3:30 AM!

Drivesafe Total

$0.00

Billing Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Please provide a link to your event's social media page

Number of Walksafe Volunteers Requested *

Please note that Walksafe operate in teams of two, so this value must be 2, 4, or 6, etc.

Additional Comments

Please Indicate whether you agree to the MSERT Terms and Conditions, described below. *

I agree

I understand that if the event is outside of the downtown McGill campus, MSERT responders will require transport in the form of a driver or paid taxi.

I understand that we, the event organizers, are responsible for the transportation costs of MSERT responders between the event venue and McGill downtown campus at the start and end of the event. On average, the cost associated with MSERT travel to an event venue outside of the McGill downtown campus is $20.00-$25.00 (one-way).

I understand that if we, the event organizers, request MSERT responders to be present at an event later than 12 am, then we are also responsible for covering any fees associated with their transport to their homes from the McGill downtown campus. On average, the cost associated with the transportation of MSERT responders to their homes is $20.00.

I understand that if the event contact(s) is/are not present within 30 minutes of responders’ arrival, MSERT responders may leave the event at their own discretion.

I understand that if MSERT responders are requested more than 30 minutes before the start of an event, then the responders have the right to leave the event at their own discretion.

I agree to ensure that the event coordinators are available to help MSERT when necessary. This includes supplying MSERT with a table, enough chairs for responders and 1-2 patients, a garbage bin/bag, and shelter (in the form of a tent, canopy, or similar structure) if the event is outdoors. If the event organizers do not provide a suitable space within 30 minutes of the arrival time, the MSERT responders may leave the event at their own discretion as it may severely impact the quality of response/patient care.

Please Indicate where you agree to the Drivesafe Terms and Conditions, described below. *

I agree

I understand that DriveSafe volunteers has the authority to reject any passengers, within reason, even if MSERT advises that they board a DriveSafe vehicle.
I understand that DriveSafe does not tolerate any verbal abuse towards DriveSafe volunteers or pressure to take rejected passengers. If these conditions persist, DriveSafe volunteers retain full authority to leave the event at their own discretion.
I understand that additional provisions and conditions are available in the DriveSafe agreement, which will be made available within 5 business days.

Please Indicate where you agree to the Walksafe Terms and Conditions, described below. *

I agree

I understand that Walksafe volunteers have the authority to reject any client, within reason.

I understand that Walksafe does not tolerate any verbal abuse towards Walksafe volunteers. Walksafe volunteers reserve the right to leave the event at their own discretion if conditions are unfavourable.

I understand that Walksafe begins operating at 9 PM, and therefore Walksafe volunteers will be dispatched at this time to head over to the event location.

I understand that the exact time at which Walksafe volunteers will arrive will depend on the distance from the Walksafe office.

I understand that Walksafe volunteers require a designated location near the entrance of the event that is easily accessible to the attendants participating.

I understand that Walksafe volunteers will make rounds every 30 minutes.

I understand that it is the responsibility of the event organizers to inform event security, all event organizers, and participants of Walksafe’s presence.
I understand that there may be a Walksafe shift change during the event.