RISK ASSESSMENT
(SELF-EVALUATION FORM)

PLEASE COMPLETE THIS FORM WITH YOUR PERSONAL DETAILS AND CHOOSE
WHICH OF THESE 'RISK CATEGORIES' BEST DESCRIBES YOUR DISABILTY.

GREEN
I am able to proceed to a safe place of refuge with the help of my assistant
GREEN / AMBER
I am able to proceed to a safe place of refuge with the help of my assistant and ONE other person
AMBER
I am able to proceed to a safe place of refuge only with the help of my assistant and TWO STEWARDS
AMBER / RED
(Wheelchair users only)
I am unable to proceed to a safe place of refuge without the assistance of FOUR STEWARDS
each supporting a corner of my wheelchair
RED
(Wheelchair users only)
I am unable to proceed to a safe place of refuge without the assistance of FOUR STEWARDS
plus auxiliary aides such as a ramp


THEN CLICK THE 'SEND FORM' BUTTON AT THE FOOT OF THE PAGE.

PLEASE ENTER YOUR FULL NAME
TELEPHONE NUMBER
E-MAIL ADDRESS
MUDSA MEMBERSHIP NUMBER
NAME OF YOUR ASSISTANT
PLEASE CHOOSE YOUR RISK CATEGORY