PRODUCTION TITLE: SHOOT DATE/S: PRODUCTION OFFICE PHONE/MOBILE:

LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location)

Complete the following table rating each risks severity on scale from Negligible (N), Low risk (L), Moderate risk (M), Severe (S), Very severe (V) each risks likelihood on scale from Very unlikely (VU), Unlikely (U), Possible (P), Likely (L), Very likely (VL) Determine the risk factor from the table overleaf.

Hazard Present? Severity Likelihood Risk Factor

1 Alcohol/drugs

2 Animals/insects / M p 3

3 Audiences

4 Camera cable/grip equipment

5 Confined spaces

6 Derelict buildings/dangerous structures

7 Electricity/gas (other than normal supplies)

8 Fatigue/long hours

9 Fire/flammable materials

10 Hazardous substances

11 Heat/Cold/extreme weather / M P 3

12 Laser/strobe effects

13 Machinery/industrial/ crane/hoist

14 Materials - glass, non-fire retardant set materials

15 Night operation

16 Noise – high sound levels

17 Non standard manual handling

18 Public/crowds / M L 3

19 Radiation

20 Scaffold/Rostra

21 Smoking on set

22 Special effects/explosives

23 Special needs (elderly, disabled, inexperienced)

24 Specialised rescue/first aid

25 Stunts, dangerous activities

26 Tall scenery/suspended ceilings

27 Vehicles/speed

28 Water/proximity to water

29 Weapons

30 Working at heights

31 Working overseas

32 Other risks

Calculate the Risk Factor:Very Unlikely Unlikely Possible Likely Very Likely

Very severe 3 4 4 5 5Severe 2 3 3 3 5Moderate 2 2 3 3 3Slight 1 2 2 3 3Negligible 1 1 2 2 3

Decide the action to take:5 Very severe Take immediate action4 Severe High priority3 Moderate Risk Programme for action2 Low Risk Action may be required1 Negligible Probably acceptable

Then list each risk identified

LO

CA

TIO

N R

ISK

AS

SE

SS

ME

NT

FO

RM

Hazard no:2 Risk Factor (1-5) 3Description As we will be filming outside there will be risk of nearby animals and insects

interrupting the filming

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )

C

Action to take I will have my assistant director check that the shot is free from animals and try to shut down the situation

Person/company responsible for action

Assistant director

To be completed at agreed later date -Exposed person(s) informed? (y/n)

y Agreed action taken? (y/n) y Risk removed? (y/n) y

Hazard no:11 Risk Factor (1-5) 3Description The weather could be extreme and prevent filming and cause injury

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )

C

Action to take I will check the forecast before and on the morning of filming if it is raining or too windy I will cancel filming and reschedule

Person/company responsible for action

Director (aka me)

To be completed at agreed later date -Exposed person(s) informed? (y/n)

y Agreed action taken? (y/n) y Risk removed? (y/n) y

Hazard no18 Risk Factor (1-5) 3Description The public has access to where we will be filming so there might be problem with

people entering the shot or putting the public into danger.

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )

P/C

Action to take My Assistant director will make sure that the path way is clear and that nobody is harmed.

Person/company responsible for action

Assistant Director

To be completed at agreed later date -Exposed person(s) informed? (y/n)

y Agreed action taken? (y/n) y Risk removed? (y/n) y

Copy and paste this table for each of the hazards, then get the form signed. If the producer has not completed the risk assessment, then they should countersign this form.

Completed by: Amelia Hart Position: Director

Signature Amelia Hart Date: 07/10/2014

Countersigned by: Gillian Edwards PRODUCER

Signature Gillian Edwards Date:07/10/2014