This document is a filming risk assessment form for an event taking place on November 10th, 2015 at a home location. It identifies hazards from cooking on a gas stove, using a knife to cut food, and pouring boiling water. For each hazard, it lists the persons at risk as the actress and current risk level. Actions are identified to minimize the risks, such as informing the actress of dangers and using proper techniques, and new lower risk levels are given. The form is to be signed and dated upon completion.

1. Filming Risk Assessment Form
Event: Shoot 1 Date: 10th
November
2015
Location
:
Home
(1)
Activity /
Area of
Concern
i.e.: what is
taking place as
part of the
event?
(2)
Hazards Identified
i.e.: what can
cause harm?
(3)
Persons at Risk
i.e.: who could be
harmed by the
hazard?
(4)
Current Risk
Factor
(high, medium
or low)
i.e.: determine
the level of
risk
(5)
Actions to be Taken to Minimize each
Risk
i.e.: what action can you take to lower the
level of risk
(6)
New Risk
Factor
(high, medium
or low)
i.e.: risk factor
after action
taken to
minimize the
risk
The subject of
the film will be
cooking upon a
gas lit stove
Hot pans and/or
burning themselves
on the hob itself.
The actress Medium Inform the actress of the danger, and use
heat resistant cooking apparatus.
Low
Using a knife to
cut up food
The knife is sharp
and can cut the
fingers.
The actress Medium Make sure the actress is aware of the
danger and knows how to hold the knife to
avoid cutting themselves on the blade.
Low
Pouring boiling
water
The water is going
to be above 100
degrees so can
burn.
The actress Low Ensure the atress is aware of the danger,
and make sure they hold it in a manner
that will:
1. Keep their skin away from the water
2. Make sure they don’t drop it
accidentally
Name of person completing Risk Assessment (printed): ………………………………………………………….
Signature: ………………………………………………… Date: ………………………….