Appendix F6 - CMO questionnaire - Track Racing (incl. SpeedwayGP)

CIRCUIT CMO QUESTIONNAIRE

APPENDIX F6 - Track Racing, incl. SpeedwayGP (art. 09.6.1 of the Medical Code)
This questionnaire must be completed by the Chief Medical Officer (CMO) and returned to the FIM: cmi@fim.ch 2 months prior to the event
A copy of this form has to be handed over before the first track inspection to the FIM Medical Delegate.
Included:
1) EVENT INFORMATION
2) CHIEF MEDICAL OFFICER

3) MEDICAL SERVICES

Rows	YES	NO
Are all medical services under the control of the Chief Medical Officer (CMO)

3a) NUMBER OF MEDICAL PERSONNEL

Rows	Day 1	Day 2
Number

Rows	Day 1	Day 2
Number

4c)

Rows	YES	NO
Do positions conform to map of sections?
Doctor as per Medical Code
Personnel as per Medical Code

4d) MEDICAL EQUIPMENT

Rows	YES	NO
Stretcher
Oxygen supply
Equipment to immobilise limbs and spine
First aid medicaments and materials

4e) TECHNICAL EQUIPMENT

Rows	YES	NO
Radio Communication with the Race Director and CMO (if applicable)
Visible and audible signals

Rows	Day 1	Day 2
Number

5b)

Rows	YES	NO
Do positions conform to map of sections?

5c) MEDICAL PERSONNEL

Rows	YES	NO
Doctor, nurse, paramedic or equivalent experienced in emergency care, stretcher bearer

5d) MEDICAL EQUIPMENT

Rows	YES	NO
Equipment for initiating resuscitation and emergency treatment
Cervical collar
Scoop stretcher

5e) TECHNICAL EQUIPMENT

Rows	YES	NO
Radio communication with Race Director (if applicable) and CMO

6a) OTHER MEDICAL FACILITY

Rows	YES	NO
Is a facility available for treatment of injured riders (e.g., room, container or tent, etc.) ?

Rows	Day 1	Day 2
Number

8) RACES WITH CHILDREN (15 years and under) - Art. 09.8

Rows	YES	NO
Doctor expert in paediatric trauma
Equipment, monitoring devices and medications suitable for children

9) CLOTHING OF MEDICAL PERSONNEL AS PER MEDICAL CODE

Rows	YES	NO
Doctor
Paramedics or equivalent

Rows	YES	NO
Are there anti-doping facilities

10b)

Rows	YES	NO
Are chaperones available on site for the doping control officers?
Is a waiting area with seating available for riders?
Are sealed bottles of still water available for the riders?

11a) HOSPITALS

Rows	Name of the hospitals (local, general, ortho-trauma, etc) & Tel. N°
Local hospital
General surgery
Orthopaedic/trauma surgery

11b) HOSPITALS

Rows	Address/GPS coordinates-Google map
Local hospital
General surgery
Orthopaedic/trauma surgery

11c) HOSPITALS

12) CIRCUIT CMO QUESTIONNAIRE

Rows	YES	NO
This questionnaire has been completed by the CMO, medical service is in accordance with art. 09.7.11 of the Medical Code