PRODUCTION TITLE: Inside My Head Music Video SHOOT DATE/S: 30/10/2013 PRODUCTION OFFICE PHONE/MOBILE: 07889030423

LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location) The Robert Kett Public House

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

3 Audiences YES L VL 3

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

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 YES L L 3

19 Radiation

20 Scaffold/Rostra

21 Smoking on set YES L VL 3

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 3Low 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: 3/18 Risk Factor (1-5) 3Description There will most likely be an audience/ public crowd as it is a public and popular

area

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

Cast and Crew: Myself, Dante, Jack, Luke Deano, Maisie and Ayden

Action to take Corner off the area we are using

Person/company responsible for action

Myself

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

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

Hazard no: 21 Risk Factor (1-5) 3Description The majority of my cast and crew smoke so there will be smoking on set

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

Cast and Crew: Myself, Dante, Jack, Luke Deano, Maisie and Ayden. Also some members of the public might be exposed.

Action to take It is public land and outside, so completely legal to smoke, although my cast and crew have agreed to stand away from the equipment, and any bystanders

Person/company responsible for action

Myself

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

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

Hazard no: Risk Factor (1-5)Description

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

Person/company responsible for action To be completed at agreed later date -Exposed person(s) informed? (y/n)

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

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: Sofia Morana Position: Director

Signature Date: 25/10/13

Countersigned by: Sofia Morana PRODUCER

Signature Date: 25/10/2013