RISK ASSESSMENT FORM

PRODUCTION TITLE: Mosaik Aerial Music Video SHOOT DATE/S: 11.11.15LOCATION THIS FORM RELATES TO: Norwich City Centre 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.

HazardPresent?

SeverityLikelihoodRisk Factor

1Alcohol/drugs

2Animals/insects

3Audiences

4Camera cable/grip equipmentYesMU2

5Confined spaces

6Derelict buildings/dangerous structures

7Electricity/gas (other than normal supplies)

8Fatigue/long hoursYesLL3

9Fire/flammable materials

10Hazardous substances

11Heat/Cold/extreme weather

12Laser/strobe effects

13Machinery/industrial/ crane/hoist

14Materials - glass, non-fire retardant set materials

15Night operation

16Noise high sound levels

17Non standard manual handling

18Public/crowdsYesLU2

19Radiation

20Scaffold/Rostra

21Smoking on set

22Special effects/explosives

23Special needs (elderly, disabled, inexperienced)

24Specialised rescue/first aid

25Stunts, dangerous activities

26Tall scenery/suspended ceilings

27Vehicles/speedYesSU3

28Water/proximity to water

29Weapons

30Working at heights

31Working overseas

32Other risks

Calculate the Risk Factor:Very UnlikelyUnlikelyPossibleLikelyVery Likely

Very severe34455

Severe23335

Moderate22333

Slight12233

Negligible11223

Decide the action to take:

5Very severeTake immediate action

4SevereHigh priority

3Moderate RiskProgramme for action

2Low RiskAction may be required

1NegligibleProbably acceptable

Hazard no: 4Risk Factor (1-5)2

DescriptionI will be using a large tripod and a small camera stabilizer with my camera mounted on top

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )People exposed to: Director, actor, assisting crew and the public

Action to takeEquipment will be carried and moved with care, with any external wiring being taped down to the equipment and made to stand out with red tape

Person/company responsible for action Director

To be completed at agreed later date -

Exposed person(s) informed? (y/n)YAgreed action taken? (y/n)YRisk removed? (y/n)Y

Hazard no: 8 Risk Factor (1-5)3

DescriptionThere will be a lot of walking around the Norwich city centre, in addition to this the crew will be helping to carry slightly heavy equipment

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )People exposed to: Director, actor, assisting crew

Action to takeRegular rest breaks and I will ask if all of the crew are okay to continue with filming

Person/company responsible for action Director

To be completed at agreed later date -

Exposed person(s) informed? (y/n)YAgreed action taken? (y/n)YRisk removed? (y/n)Y

Hazard no: 18Risk Factor (1-5)2

DescriptionThe public will be present due to the filming taking place in the Norwich city centre in public areas

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )People exposed: Director, actor, assisting crew

Action to takeTo keep all crew in close proximity so nobody is lost within any crowds or negatively affected by the people of the public

Person/company responsible for action Director

To be completed at agreed later date -

Exposed person(s) informed? (y/n)YAgreed action taken? (y/n)YRisk removed? (y/n)Y

Hazard no: 27Risk Factor (1-5)3

DescriptionThere are many roads with high speed vehicles such as cars, busses and bikes on them

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )People exposed: Director, actor, assisting crew

Action to takeAll crew will be kept off the road by a chosen over watcher, and for the camera operator a person will stand behind so they do not move into the road

Person/company responsible for action Assisting crew member

To be completed at agreed later date -

Exposed person(s) informed? (y/n)YAgreed action taken? (y/n)YRisk removed? (y/n)Y

Completed by:

Jonathan Eley

Position: Director/Producer

Signature

Date: 9.11.15

LOCATION RISK ASSESSMENT FORM