SECURE TRANSPORT BOOKING FORM

AMBULANCE BOOKING FORM

Average time to complete is 5 minutes

 
 
 
 
 
 
 
 
 
 
 
 
 
High Secure with Secure Cell
High Secure
Low Secure
Mobility - Wheelchair access
 
 
Informal
Section 2
Section 3
Section 37
Section 37/41
Section 47
Section 47/49
Section 38
Section 48
Section 48/49
Other
 
 
 
 
Male
Female
 
Yes
No
 
Yes
No
 
 
Absconsion Risk
Physical Aggression
Verbal Aggression
Sexually inappropriate behaviour
Self harm
Gender Issues (staffing preference)
Racial Issues (staffing preference)
 
 
 
 
Yes
No
Unknown
 
 
Sight
Hearing
Intoxication
Other
 
 
Yes
No
 
Yes
No
Unknown
 
Yes
No
 
Driver Only
Driver plus one escort (Recommended for Non-Secure (Low Risk) and Informal Patients)
Driver plus two escorts (Recommended for medium Risk Patients)
Driver plus three escorts (Recommended for High Risk Patients)
 
 
None
One
Two
Three
 
Yes
No