![Risk Assessment Form – Part A Blank Template
Reference: None required Sign-off status Approved
Assessment summary details
Assessment title *
(Simple name for reference
purposes)
“Put Your Records On” music video
Division:* Production Department:* Media
Series/ Prod/Unit: Music video Programme/Area:
Responsible Manager: Mariel Racaza
Eiriel De Roxas
Contact office: Netherhall School and Sixth
Form Centre
Address/Tel: 10 Long Reach Road
CB4 1UH
13 Spalding Way
CB1 8NP
Address/Tel: Queen Edith’s Way
CB1 8NN
01223242931
Date assessment created 14/10/2014 Confidential risk
assessment?
NO
Assessment Outline
(Summary of what is
proposed)
The filming of a music video, to check that the locations are safe to use
Assessment start date 14/10/2014 Review / End date 15/10/2014
Country location England Hostile / travel
advisory?
NO
Location details · Lion Yard
CB2 3ET
· New Square Park
CB1 1EY
· Netherhall School
CB1 8NN
· 13 Spalding Way
CB1 8NP
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)
Mariel Racaza – Director
Eiriel De Roxas – Cameraman
Kevin Racaza – Cameraman
Julie Nasayao – Lighting Assistant
Jason Garcia – Crew hands
[* mandatory fields]](https://image.slidesharecdn.com/musicvideoriskassessment-141015155534-conversion-gate01/85/Music-Video-Risk-Assessment-1-320.jpg)
![Risk Assessment Form – Part A Blank Template
Attachments
(Detail supporting
documents)
Assessor(s) *
(Person drafting risk
assessment)
Mariel Racaza
Eiriel De Roxas
Assessor safety
competence
Medium
Authoriser(s) *
(Person responsible for
sign-off)
Mr Day Date signed-off * 15/10/2014
Distribution
(Who gets a copy of the
assessment)
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 in the park Cast, crew and bystanders · Bystanders could
kick the tripod
and damage it
· People playing
with a ball in the
park could kick
the ball and hurt
the cast/crew and
break equipment
· LOW
· LOW
Filming in city streets Cast, crew and bystanders · Bystanders could
kick the tripod
and damage it
· Cars passing
could get
distracted.
· Cars could hit
crew members,
bystanders, and
actors.
· LOW
· LOW
· MEDIUM
Filming in the media studio Cast and crew · Cast and crew
could trip over
tripods and wires
· LOW
Filming in a living room Cast and crew · Cast and crew
could trip over
tripods, wires and
plugs
· Owner of the
house has a dog
· LOW
· MEDIUM
· LOW
[* mandatory fields]](data:image/gif;base64,R0lGODlhAQABAIAAAAAAAP///yH5BAEAAAAALAAAAAABAAEAAAIBRAA7)
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Music Video Risk Assessment
- 1. Risk Assessment Form – Part A Blank Template Reference: None required Sign-off status Approved Assessment summary details Assessment title * (Simple name for reference purposes) “Put Your Records On” music video Division:* Production Department:* Media Series/ Prod/Unit: Music video Programme/Area: Responsible Manager: Mariel Racaza Eiriel De Roxas Contact office: Netherhall School and Sixth Form Centre Address/Tel: 10 Long Reach Road CB4 1UH 13 Spalding Way CB1 8NP Address/Tel: Queen Edith’s Way CB1 8NN 01223242931 Date assessment created 14/10/2014 Confidential risk assessment? NO Assessment Outline (Summary of what is proposed) The filming of a music video, to check that the locations are safe to use Assessment start date 14/10/2014 Review / End date 15/10/2014 Country location England Hostile / travel advisory? NO Location details · Lion Yard CB2 3ET · New Square Park CB1 1EY · Netherhall School CB1 8NN · 13 Spalding Way CB1 8NP 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) Mariel Racaza – Director Eiriel De Roxas – Cameraman Kevin Racaza – Cameraman Julie Nasayao – Lighting Assistant Jason Garcia – Crew hands [* mandatory fields]
- 2. Risk Assessment Form – Part A Blank Template Attachments (Detail supporting documents) Assessor(s) * (Person drafting risk assessment) Mariel Racaza Eiriel De Roxas Assessor safety competence Medium Authoriser(s) * (Person responsible for sign-off) Mr Day Date signed-off * 15/10/2014 Distribution (Who gets a copy of the assessment) 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 in the park Cast, crew and bystanders · Bystanders could kick the tripod and damage it · People playing with a ball in the park could kick the ball and hurt the cast/crew and break equipment · LOW · LOW Filming in city streets Cast, crew and bystanders · Bystanders could kick the tripod and damage it · Cars passing could get distracted. · Cars could hit crew members, bystanders, and actors. · LOW · LOW · MEDIUM Filming in the media studio Cast and crew · Cast and crew could trip over tripods and wires · LOW Filming in a living room Cast and crew · Cast and crew could trip over tripods, wires and plugs · Owner of the house has a dog · LOW · MEDIUM · LOW [* mandatory fields]
- 3. and it might disrupt the flow of filming · Figurines displayed could get knocked over. Comments log Who by Date / time received Comments Assessor response Date/ time responded Risk Assessment Form – Part B 6Reference: None required Sign-off status 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 are you going to prevent this from happening? Activity Title:* Sitting in the park and lip syncing Activity Description: Two actors sitting in the park being intimate. One of them lip syncs. List those managing this Activity and their competence: Mariel Racaza – Director Eiriel De Roxas – Director Kevin Racaza – Cameraman Julie Nasayao – Lighting Assistant Who & how many are at risk from this Activity? Cast and crew Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Bystanders could kick the tripod and damage it. Keep a lookout for bystanders that are near and make sure People playing with a ball in the park could kick the ball and hurt the Move away from people playing with a ball. cast/crew and break equipment. Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Low Risk Assessment Form – Part B 6Reference: None required Sign-off status 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 are you going to prevent this from happening? [* mandatory fields]
- 4. Activity Title:* Walking through the city Activity Description: Actors walking in the streets with one of them lip syncing. List those managing this Activity and their competence: Mariel Racaza – Director Eiriel De Roxas – Director Kevin Racaza – Cameraman Julie Nasayao – Lighting Assistant Who & how many are at risk from this Activity? Cast and crew Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Bystanders could kick the tripod and damage it. Keep a lookout for bystanders that are near and make sure Cars passing could get distracted. Having a crew member to have as a lookout to make sure Cars could hit crew members, bystanders, and actors. Having a crew member to have as a lookout and make sure and actors to lookout and stay away from traffic. Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Low Risk Assessment Form – Part B 6Reference: None required Sign-off status 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 are you going to prevent this from happening? Activity Title:* Living room Activity Description: Actor is sitting by the window lip syncing. She gets up and walks away. List those managing this Activity and their competence: Mariel Racaza – Camerawoman Eiriel De Roxas – Director Julie Nasayao – Lighting Assistant Who & how many are at risk from this Activity? Cast and crew Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Cast and crew could trip over tripods and plugs Make sure to keep the plugs out of the way and remove [* mandatory fields]
- 5. Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Owner of the house has a dog and it might disrupt the flow of filming Keep the dog away, preferably a separate room. Figurines displayed could get knocked over Put away from the filming site during filming and make sure their surroundings. Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Low Risk Assessment Form – Part B 6Reference: None required Sign-off status 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 are you going to prevent this from happening? Activity Title:* Projected wall and plain background Activity Description: Actor is leaning against the wall, lip syncing. List those managing this Activity and their competence: Mariel Racaza – Camerawoman Eiriel De Roxas – Director Julie Nasayao – Lighting Assistant Who & how many are at risk from this Activity? Cast and crew Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Cast and crew could trip over tripods Make sure to keep the tripods out of the way and remove Risk Level*: After your controls have been applied what is your assessment of the risk level of this Low activity? [* mandatory fields]
- 6. Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Owner of the house has a dog and it might disrupt the flow of filming Keep the dog away, preferably a separate room. Figurines displayed could get knocked over Put away from the filming site during filming and make sure their surroundings. Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Low Risk Assessment Form – Part B 6Reference: None required Sign-off status 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 are you going to prevent this from happening? Activity Title:* Projected wall and plain background Activity Description: Actor is leaning against the wall, lip syncing. List those managing this Activity and their competence: Mariel Racaza – Camerawoman Eiriel De Roxas – Director Julie Nasayao – Lighting Assistant Who & how many are at risk from this Activity? Cast and crew Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Cast and crew could trip over tripods Make sure to keep the tripods out of the way and remove Risk Level*: After your controls have been applied what is your assessment of the risk level of this Low activity? [* mandatory fields]