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Risk Assessment Form – Part A
Reference:

Sign-off status

[enter reference number]]

Blank Template

[planning/approved etc]

Assessment summary details
Assessment title *
(Simple name for reference
purposes)

Health and safety

Production

Division:*

Department:*

Series/ Prod/Unit:

Programme/Area:

Sam Rees

Responsible
Manager:

Contact office:

Address/Tel:

Address/Tel:

Date assessment created

Assessment Outline
(Summary of what is
proposed)
Assessment start
date

16.10.13

Confidential risk
assessment?

NO

Creating and filming a music video

16.10.13

Review / End date

1.11.13

Country location

Cambridge, England

Hostile / travel
advisory?

Location details

Colville Rd, Cambridge
CB1 9EJ

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)

Sam Rees- Camera man, Director
Josh Fowell- Camera assistant

Attachments
(Detail supporting
documents)
Assessor(s)

*

Sam Rees

Assessor safety
competence

MR Shephard

Date signed-off *

(Person drafting risk
assessment)
Authoriser(s) *
(Person responsible for
sign-off)
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

Filming on streets

Cast and crew

Car crash

Activity Risk Rating
low

Comments log
Who by

Date / time
received

[* mandatory fields]

Comments

Assessor response

Date/ time
responded
Risk Assessment Form – Part B
Reference:

6

Sign-off status

[enter reference number]]

ACTIVITIES:
What are you doing, where, for how long and who will be
involved? Complete the fields in the form below).
Activity Title:*

[planning/approved etc]

HAZARDS & CONTROLS:
How could someone become hurt or made ill and
how are you going to prevent this from happening?

Filming on stage

Activity Description:

Blank Template

Stage could injure people

List those managing
this Activity and their
competence:

Sam Rees- director

Who & how many are
at risk from this
Activity?

8 cast and crew

Hazards
How could someone become hurt or made ill

Control measures
How are you going to prevent this from happening?

Fall off stage

Tell people about the risks and have people watch out for the danger.

[Hazard 2 title and description]

[Details of control measures]

[add additional rows as required]

Risk Level*: After your controls have been applied what is your assessment of the risk level of
this activity?

Add additional activities as required – by copying this section and pasting below

[* mandatory fields]

High/Medium/Low

(delete as applicable)
[* mandatory fields]

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risk assessment

  • 1. Risk Assessment Form – Part A Reference: Sign-off status [enter reference number]] Blank Template [planning/approved etc] Assessment summary details Assessment title * (Simple name for reference purposes) Health and safety Production Division:* Department:* Series/ Prod/Unit: Programme/Area: Sam Rees Responsible Manager: Contact office: Address/Tel: Address/Tel: Date assessment created Assessment Outline (Summary of what is proposed) Assessment start date 16.10.13 Confidential risk assessment? NO Creating and filming a music video 16.10.13 Review / End date 1.11.13 Country location Cambridge, England Hostile / travel advisory? Location details Colville Rd, Cambridge CB1 9EJ 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) Sam Rees- Camera man, Director Josh Fowell- Camera assistant Attachments (Detail supporting documents) Assessor(s) * Sam Rees Assessor safety competence MR Shephard Date signed-off * (Person drafting risk assessment) Authoriser(s) * (Person responsible for sign-off) 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 Filming on streets Cast and crew Car crash Activity Risk Rating low Comments log Who by Date / time received [* mandatory fields] Comments Assessor response Date/ time responded
  • 2. Risk Assessment Form – Part B Reference: 6 Sign-off status [enter reference number]] ACTIVITIES: What are you doing, where, for how long and who will be involved? Complete the fields in the form below). Activity Title:* [planning/approved etc] HAZARDS & CONTROLS: How could someone become hurt or made ill and how are you going to prevent this from happening? Filming on stage Activity Description: Blank Template Stage could injure people List those managing this Activity and their competence: Sam Rees- director Who & how many are at risk from this Activity? 8 cast and crew Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Fall off stage Tell people about the risks and have people watch out for the danger. [Hazard 2 title and description] [Details of control measures] [add additional rows as required] Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Add additional activities as required – by copying this section and pasting below [* mandatory fields] High/Medium/Low (delete as applicable)