1. Risk Assessment Form – Part A Blank Template
Reference: [enter reference number]] Sign-off status [planning/approved etc]
Assessment summary details
Assessment title * Health and safety form
(Simple name for reference
purposes)
Division:* Production Department:* Drama
Series/ Prod/Unit: Programme/Area:
Responsible Siobhan Coleman Contact office:
Manager:
Address/Tel: Address/Tel:
Date assessment created 8th February 2013 Confidential risk NO
assessment?
Assessment Outline
(Summary of what is
proposed)
Assessment start 8th February 2013 Review / End date
date
Country location England Hostile / travel
advisory?
Location details Office at Cintra. Cambridge NB: If the country location selected is ‘Hostile’ you are
required to: complete the BBC Overseas High Risk
Assessment Form
Crew / team Scarlett Diver-Director
(Roles, responsibilities, Sophie Maccallum-Camera
competencies) Siobhan Coleman-Producer
Attachments
(Detail supporting
documents)
Siobhan Coleman
Assessor(s) * Assessor safety
(Person drafting risk competence
assessment)
Authoriser(s) * Brendan Sheppard Date signed-off *
(Person responsible for
sign-off)
Distribution
(Who gets a copy of the Data Protection Act: Personal information collected for the purposes of risk assessment will be used to identify those at risk, and
those involved in controlling risk, from this or similar activities and to fulfil the BBC's obligations under Health and Safety policy and
assessment) legislation. It will be retained for up to 6 years after the expiry of the activity. It may be shared with other organisations, including
our agents and contractors, with whom the risk or the control of risk is shared.
Activity and Hazard Summary [This is a summary of the activities listed in part B of the risk assessment.]
Activity Who Exposed Hazards{hazard titles Activity Risk Rating
Filming on stairs or outside. Cast and crew Being hit car or falling LOW
Comments log
Who by Date / time Comments Assessor response Date/ time
received responded
[* mandatory fields]

2. Risk Assessment Form – Part B Blank Template
Reference:
6 [enter reference number]] Sign-off status [planning/approved etc]
ACTIVITIES: What are you doing, where, for how long and who will be HAZARDS & CONTROLS: How could someone become hurt or made ill and
involved? Complete the fields in the form below). how are you going to prevent this from happening?
Activity Title:* [activity 1 title] Filming whilst walking up the stairs
Activity Description:
List those managing Siobhan Coleman –Producer
this Activity and their Scarlett Diver - Director
competence:
Who & how many are Cast and crew members
at risk from this
Activity?
Hazards Control measures
How could someone become hurt or made ill How are you going to prevent this from happening?
When filming walking up the stairs either crew and cast could Have one of the crew members keeping watch at all times.
fall down the stairs.
When filming outside on the street and road there is a possibility Have one of the crew members keeping watch at all times.
of either cast or crew to be hit by a car.
Risk Level*: After your controls have been applied what is your assessment of the risk level of Low
this activity?
Add additional activities as required – by copying this section and pasting below
[* mandatory fields]

3. [* mandatory fields]