This risk assessment form evaluates potential hazards for a film shoot at Dolls Domain. Several low risk hazards are identified, including animals/insects, derelict buildings, night operations, public crowds, tall scenery, and slippery floors. Actions to mitigate these risks include keeping pets locked away, scanning structures for stability, using lights after dark, maintaining a safe distance from equipment, and wearing appropriate footwear. Makeup allergies are also noted as a low risk for crew, to be addressed through skin testing and allergen-free products. The form documents 32 total hazards were considered, with most deemed very unlikely and negligible. Responsibility for actions falls to the location manager, Mernaya Dalton.

1. RISK ASSESSMENT FORM
4-03-2016 Dolls Domain Page 1 of
Mernaya
Location:
Address:
RATINGS:
• 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)
• risk factor from the table overleaf.
Hazard Present? Severity Likelihood Risk
Factor
1 Alcohol/drugs N N VU 1
2 Animals/insects Y L U 1
3 Audiences N L U 1
4 Camera cable/grip equipment Y L U 1
5 Confined spaces N N VU 1
6 Derelict buildings/dangerous structures Y L U 1
7 Electricity/gas (other than normal supplies) N N VU 1
8 Fatigue/long hours N N VU 1
9 Fire/flammable materials N N VU 1
10 Hazardous substances N N VU 1
11 Heat/Cold/extreme weather N N VU 1
12 Laser/strobe effects N N VU 1
13 Machinery/industrial/ crane/hoist N N VU 1
14 Materials - glass, non-fire retardant set materials N N VU 1
15 Night operation Y L U 1
16 Noise – high sound levels N N VU 1
17 Non standard manual handling N N VU 1
18 Public/crowds Y L U 1
19 Radiation N N VU 1
20 Scaffold/Rostra N N VU 1
21 Smoking on set N N VU 1
22 Special effects/explosives N N VU 1
23 Special needs (elderly, disabled, inexperienced) N N VU 1
24 Specialised rescue/first aid N N VU 1
25 Stunts, dangerous activities N N VU 1
26 Tall scenery/suspended ceilings Y L U 1
27 Vehicles/speed N N VU 1
28 Water/proximity to water N N VU 1
29 Weapons N N VU 1
30 Working at heights N N VU 1
31 Working overseas N N VU 1
32 Other risks 1
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

2. Low 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
Hazard no: 2
Description Animals and Insects – May be present on public pathways and
grounds such as forest and in Megan and Kayas house.
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
COP
Action to take Keep family pets locked in a different room. Very low risk, most likely
negligible.
Make sure to watch out for any animals in public, if one approaches
stay calm and pet it. Use insect spray to protect against bugs.
Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Hazard no: 4 Risk Factor (1-5):
Description Camera and equipment, possible tripping hazard. Very low.
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
POC
Action to take In order to prevent this put up a sign with a warning about loose wires
and equipment laying around. Make sure all kept tidy.
Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Hazard no: 6 Risk Factor (1-5):
Description Derelict Buildings and Dangerous structures. Low risk.

3. Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
POC
Action to take Make sure none of the buildings are going to break or fall. Keep area
clear.
Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Hazard no: 15 Risk Factor (1-5):
Description Night Operation. Low Risk
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
POC
Action to take Bring little lights with us so we can see, bring a responsible adult sso
we are not in harms way.
Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Hazard no: 18 Risk Factor (1-5):
Description Public Crowds, Low risk
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
POC
Action to take Be wary of public, Make sure they cannot get into or touch any
equipment being used. Stay in a safe area.
Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y

4. Hazard no: 26 Risk Factor (1-5):
Description Tall Scenery, Trees in forest and surrounding buildings. Very Low Risk
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
POC
Action to take Scan area before hand to see if any trees looking wary of falling down.
Make sure to have a safe area if anything goes wrong.
Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Hazard no: 32 Risk Factor (1-5):
Description Slippery floors, especially if has been raining. Very Low Risk
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
POC
Action to take Make sure wearing appropriate footwear. Put ice down on ground if
need be.
Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Hazard no: 32 Risk Factor (1-5):
Description Allergy to make-up. Low Risk
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
C
Action to take Make sure allergies are in check, do skin testing days prior. Use
allergy free make-up.

5. Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Completed by: Kaya Dalton Position:
Signature Date:

6. Person/company
responsible for action
Mernaya
To be completed at agreed later date
Exposed person(s)
informed? (y/n)
Y Agreed action taken? (y/n) Y Risk removed?
(y/n)
Y
Completed by: Kaya Dalton Position:
Signature Date: