1. RISK
ASSESSMENT FORM
• NAME OF PRODUCTION: The Fault in Our Stars Reconstruction
• Production number : 2
• Production office telephone: 07581714097
• Shoot dates:
• 19/01/17
• List of location(s), form relates to:
CCAD Studio, Church Street, Hartlepool
• Production manager name and mobile number;
Lydia Marley -Lawson , 07581714097
• 1st AD name and mobile;
Chloe Vennard, 07393307048
• (exec) Producer name and mobile.
Lydia Marley -Lawson , 07581714097
Complete the following table rating
• each risks severity on scale from Negligable (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 P
r
e
s
e
nt
?
S
e
v
e
r
i
t
y
L
i
k
e
l
i
h
o
o
d
Ris
k
Fa
cto
r
1 Alcohol/drugs
2 Animals/insects
3 Audiences
2. 4 Camera cable/grip equipment Y M P 3
5 Confined spaces Y L U 2
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
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
3. 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 5
Severe 2 3 3 3 5
Moderate 2 2 3 3 3
Low risk 1 2 2 3 3
Negligible 1 1 2 2 3
Decide the action to take:
5 Very severe Take immediate action
4 Severe High priority
3 Moderate Risk Programme for action
2 Low Risk Action may be required
1 Negligible Probably acceptable
Then list each risk identified
4. Hazard no:4 Camera cable/grip
equipment
Risk Factor (1-5) 3
Description As this is a shoot there will be cables and electrical
equipment on set. Therefore there is a slight hazard of
tripping on equiptment.
Person(s) exposed
(detail if cast/crew
(C), outside
company (O) or
public (P) )
C
Action to take Ensure all cast and crew are aware of the cables and
equiptment. Tape any lose cables down. Also take
caution to minimise risk by not leaving equipment lying
around.
Person/company
responsible for
action
Producer (Lydia Marley-Lawson)
To be completed at agreed later date -
Exposed person(s)
informed? (y/n)
Agreed action taken?
(y/n)
Risk removed?
(y/n)
Hazard no:5 Confinded spaces Risk Factor (1-5) 2
Description This shoot will take place in a studio which means long
periods of time in a confined space.
Person(s) exposed
(detail if cast/crew
(C), outside
company (O) or
public (P) )
C
Action to take To eliminate any risks I will ensure that the cast and crew
are given designated breaks for fresh air during the shoot.
I will also ensure that the room is not cluttered as this
could cause tripping hazards in such a small area.
5. Person/company
responsible for
action
Producer (Lydia Marley-Lawson)
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:Lydia Marley-Lawson Position: Producer
Signature Date: 4/12/16
Countersigned by:Chloe Vennard DIRECTOR
Signature Date:5/12/16
Countersigned by: Lecturer
Signature Date:
