Risk Assessment

1. Risk Assessment Form – Part A Blank Template
Reference: 123456789 Sign-off status [planning/approved etc]
Assessment summary details
Assessment title *
(Simple name for reference
purposes)
Church Tower Risk Assessment
Division:* Film Production Department:* Drama
Series/ Prod/Unit: Horror/ Sci-fi Programme/Area: Clockwork
Responsible
Manager:
Anna Maxwell/ Holly
Hermance
Contact office: 49 High Street Chippenham CB7
5PR
Address/Tel: 07473434000 Address/Tel: 01638720677
Date assessment created 12.11.2014 Confidential risk
assessment?
NO
Assessment Outline
(Summary of what is
proposed)
Filming from the top of the church tower. Necessitates climbing the tower internally and
transporting camera equipment to the top of the tower. Steep stairs and ladders with
risk of falling from height. Climbing over bells also with risk of falling from height.
Uneven surfaces which are trip hazards. Top of tower is open and over 16 metres tall
parapet is of adequate height but care must be taken not to lean over. Church warden
will accompany to ensure safe use of the tower.
Filming at street level. Busy main road has traffic hazards.
Assessment start
date
14.11.2014 Review / End date 15.11.2014
Country location England Hostile / travel
advisory?
Location details Church tower, owned by the
diocese of Ely, managed by
Chippenham PCC.
Permission has been given
for filming from the tower
and the PCC will supervise
the filming.
Chippenham High Street,
public space
NB: If the country location selected is ‘Hostile’ you are
required to: complete the BBC Overseas High Risk
Assessment Form
Crew / team
(Roles, responsibilities,
competencies)
Anna Maxwell camera woman, film clips for the opening sequence of Clockwork, responsibility for
camera equipment.
Holly Hermance, director, direct camera woman and actor for Clockwork, responsibility for selecting
appropriate shots and directing the actor.
Harold Hermance, actor, act according to directors instructions.
[* mandatory fields]

2. Risk Assessment Form – Part A Blank Template
Attachments
(Detail supporting
documents)
Here is the church tower.
Assessor(s) *
(Person drafting risk
assessment)
Anna Maxwell Assessor safety
competence
Authoriser(s) *
(Person responsible for
sign-off)
Brenden Sheppard Date signed-off *
Distribution
(Who gets a copy of the
assessment)
Brendan Sheppard, Holly Hermance, Terry Cross, Chippenham PCC (Fiona.maxwell@yahoo.com)
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
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 from church tower Director, camera woman,
church warden, actor
Falling, trip hazards Medium
Filming at street level Director, camera woman,
actor
Traffic Low
Comments log
Who by Date / time
received
Comments Assessor response Date/ time
responded
[* mandatory fields]

3. Risk Assessment Form – Part B Blank Template
6Reference: 123456789 Sign-off status [planning/approved etc]
ACTIVITIES: What are you doing, where, for how long and who will be
involved? Complete the fields in the form below).
HAZARDS & CONTROLS: How could someone become hurt or made ill and
how are you going to prevent this from happening?
Activity Title:* Filming from Church tower
Activity Description: Film actor walking down the road from church tower
List those managing
this Activity and their
competence:
Holly Hermance, director, student
Anna Maxwell, camera woman, student
Terry Cross, church warden, high degree of competence
Who & how many are
at risk from this
Activity?
Director, camera woman, church warden
Hazards
How could someone become hurt or made ill
Control measures
How are you going to prevent this from happening?
Falling from height Climbing carefully under direction of church warden
Tripping on uneven floor Care to be taken at all times
Risk Level*: After your controls have been applied what is your assessment of the risk level of
this activity?
Medium
Add additional activities as required – by copying this section and pasting below
[* mandatory fields]

4. Risk Assessment Form – Part B Blank Template
6Reference: [enter reference number]] Sign-off status [planning/approved etc]
ACTIVITIES: What are you doing, where, for how long and who will be
involved? Complete the fields in the form below).
HAZARDS & CONTROLS: How could someone become hurt or made ill and
how are you going to prevent this from happening?
Activity Title:* Filming at street level
Activity Description: Filming actor walking down the road/ pavement
List those managing
this Activity and their
competence:
Holly Hermance, director, student
Anna Maxwell, camera woman, student
Who & how many are
at risk from this
Activity?
Director, camera woman, actor
Hazards
How could someone become hurt or made ill
Control measures
How are you going to prevent this from happening?
Traffic Use pavement
Risk Level*: After your controls have been applied what is your assessment of the risk level of
this activity?
Low
Add additional activities as required – by copying this section and pasting below
[* mandatory fields]