WEST SUFFOLK HOSPITAL
EDUCATION CENTRE ROOM BOOKING FORM
(Internal Users)
01) DATE(s) OF EVENT
02) ROOM REQUIRED (tick)
03) ROOM LAYOUT (tick)
Training
Lecture Hall
Computer
Resuscitation Training
Clinical Skills
Practical Skills
Interview
Theatre Style
Boardroom
Open Boardroom
Informal
Classroom
Cabaret
Interviews
Specialised Layout Required
04) CAPACITY (maximum numbers please)
05) TIME
 From
To
 Start time of event (if different)
06) IS THE EVENT? (tick)
Training/Educational
Committee/Management Meeting
Recreational
07) EVENT ORGANISERS DEPARTMENT/WARD/SPECILAITY – (Tick applicable)
SH – Cambridge Graduate Course
SH - University Campus Suffolk
SH - GPST
WSH – Nursing Directorate
WSH – Post Graduate Medical Education
WSH - Workforce
WSH – IT Training
WSH – Foundation Trust Management
WSH – West Suffolk Professionals
WSH – Wedgwood House
WSH – IT Training
WSH – Library & Learning Resources
WSH – Human Resources
WSH – Resus Services
WSH – Clinical Skills
WSH – Outreach
Or complete:
 WSH – Department  WSH – Specialty  WSH - Ward
OTHER
08) CONTACT DETAILS OF EVENT ORGANISER
(i.e.: name, email, telephone contact no :)
09) TOPIC/TITLE OF EVENT
10) NAME OF SPEAKER/ TUTOR/ CHAIRPERSON
11) WHO ARE YOUR TARGET LEARNERS?
12) IS THE AUDIENCE MULTIDISCIPLINARY? (tick)
Yes
No
12A) IF NOT, COULD IT BE? (tick & complete)
Yes
Under what circumstance? (e.g. larger venue)
No
Why? (e.g. specific teaching for a particular group)
13) ADDITIONAL EQUIPMENT REQUIRED
14) WILL REFRESHMENTS BE TAKEN IN THE ROOM? (tick)
Yes – Please read the guidelines on our confirmation letter.
No
15) ARE BREAKOUT ROOMS REQUIRED? (tick)
Yes
No
15A) IF YES
 How many
 Capacity
 From (am)
 From (pm)
To (am)
To (pm)
16) TODAY’S DATE
ROOM BOOKINGS MAY ONLY BE MADE USING THIS FORM.
PLEASE RETURN TO:

Education.bookings@wsh.nhs.uk
The Education Centre
West Suffolk Hospital NHS Trust
Hardwick Lane, Bury St Edmunds
Suffolk
IP33 2QZ
IF YOU REQUIRE HELP TO COMPLETE THIS FORM, TELEPHONE 01284 713971