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Risk assessment template
1. Risk Assessment Form –
Part A
ProductionName: Night Terror Organisation Get in for free productions
ProductionAddress: SR3 4AH Producer / Editor
Tel:
Mobile:
Luke Wilson
01915513627
07305579450
Start date 18/05/2020 End date 30/05/2020
Distribution
Who gets a copyof the assessment
Brian Wilson
Outline of risk assessment
Summary of what is proposed in
terms of sequences and set ups.
Stairs and fumitre w illbe layed out on the floor and could possibly be a bit off of a trip, hazard to those w ho
might come into the room to cross it. Also they w illbe a running scene on the stairs that may cause a
accident as could trip or miss the step that they are landing on.
Team members / experts /
contractors / contributors etc.
List those involved
Myself, Brain w ilson
Locations
Outline locationsinvolved – indicate
any which are hostile environments
33 Spar w elldrive(House) There w illbe a stair w ay scene that may cause some tripping of some kind
how everthe riskis only minimal.
Assessor Name
Signature
Neil Wilson
Neil Wilson
Date completed 12/05/2020
Authoriser Name
(if not Assessor) Signature
Neil Wilson
Neil Wilson
Date authorised 12/05/2020
Hazard list – select your hazards from the list belowand use these to complete Part B
Situational hazards Tick Physical / chemical hazards Tick Health hazards Tick
Assault by person Contact with cold liquid / v apour Disease causativ e agent
Attack by animal Contact with cold surf ace Inf ection
Breathing compressed gas Contact with hot liquid / v apour Allergic reaction
Cold env ironment Contact with hot surf ace Lack of f ood / water
Crush by load Electric shock Lack of oxy gen
Drowning Explosiv e blast Phy sical f atigue
Entanglement in mov ing machinery Explosiv e release of stored pressure Repetitiv e action
High atmospheric pressure Fire Static body posture
Hot env ironment Hazardous substance Stress / anxiety
Manual handling Ionizing radiation Venom poisoning
Object f alling, mov ing or f ly ing Laser light
Obstruction / exposed f eature Lightning strike Environmental hazards
Sharp object / material Noise Litter
Shot by f irearm Non-ionizing radiation Nuisance noise / v ibration
Slippery surf ace x Stroboscopic light Phy sical damage
Trap in mov ing machinery Vibration Waste substance released into air
Trip hazard x Waste substance released into soil / water
Vehicle impact / collision Managerial / organisational hazards
Falls f rom height x Management f actors (lack of communication,
co-operation, co-ordination and competence)
Risk matrix – use this to determine risk for
each hazard i.e. ‘how bad and how likely’ Likelihood of Harm
Severity of Harm
Remote
e.g. <1 in 1000 chance
Very unlikely
e.g. 1 in 200 chance
Unlikely
e.g. 1 in 50 chance
Possible
e.g. 1 in 10 chance
Likely
e.g. >1 in 3 chance
Negligible e.g. small bruise Trivial Trivial Trivial Low Low
Slight e.g. small cut, deep bruise Trivial Trivial Low Low Medium
Moderate e.g. deep cut, torn muscle Trivial Low Medium Medium High
Severe e.g. fracture, loss of consciousness Low Medium High High Extremely high
Very Severe e.g. death, permanent disability Low Medium High Extremely high Extremely high
2. Risk Assessment Form – Part B
Activity1
– Each individual activity you are proposing: Location – w here this activity willtake place: Dates / times:
Hazards2
List what could cause harm f rom this activ ity
e.g. falls from height, trip hazard, fire, etc.
Who exposed
List who might be harmed
f rom this activ ity
e.g. staff, contractors,
contributors, public, etc.
Risk3
For each hazard, decide
lev el of risk as if y ou were to
do the activ ity without y our
controls
Control measures
For each hazard, list the measures y ou will be taking to minimise the risk identif ied
e.g. appointing competent persons, training received, planning and rehearsals, use of personal protective
equipment, provision of first aid, etc.
Risk3
For each hazard,
decide lev el of risk
once all y our controls
are in place
Falling from heights
The Actor
Unlikely Do multiple run through and practices of running up and dow n the stairs so the actor has
practice and prepation for the finalschedule shot.
Low
Danger of w alking into furniture
The actor and camera
operators
Possible Make sure that the crew has a fulltour of the entire location/set so they have good memory
generated in their mind of the layout of the place as since it’s a dark set and it’s easily done
to w alkinto things.
Low
Continue on separate sheet if necessary
1 – complete separate table for each activity 2 - from hazard list in Part A 3 - from risk matrix in Part A