Gabriel Kelly is organizing a 3 day student film shoot taking place at an apartment in Leeds. The shoot will involve 4 students and will use cameras, lights, microphones and other film equipment. To reduce risks, cables will be taped down and equipment secured properly. The shoot does not involve anything sensitive or hazardous. With control measures like COVID testing and distancing, the overall risk is deemed low.

1. Page 1 of 7
Safety Assessment Form
Location Shoot
To be used for shoots that would not be covered under a course generic risk assessment.
Before completing this form please refer to the Film & Photography Health & Safety
Location Shoot Handbook for guidance, to ensure your shoot is as safe as is reasonably
practicable.
Organiser details
Name: Gabriel Kelly Tel: 07940034957
Course:
Level:
Level 4 Student
Number:
295301
Module
Leader:
Tom Chimiak
Title of Shoot: Button Basher
Shoot Date(s): From: 28/04/21 To: 30/04/21
Number of participants:
Total number of all persons involved. For legal reasons please
provide details of any participants under 18.
(Max 6)
4
Shoot Location: 105 Carr Mills, Buslingthorpe Ln,
LS7 2DG
Location approval received from:
If on University premises(outside of course studios) this is
required fromEstatesbefore the shoottakes place
Gabriel Kelly
State which paperwork has been submitted/received from the list below:
(As a University we do not have controlof how the externally owned venues we may want to use for exhibitions are
managed. It is therefore important that we make checks that buildings are safe and meet legislative compliance as a
public venue before we use them. We can do this by asking the venue owner/ operator to provide the relevant
documents listed below)
 Fire risk assessment & Evacuation
Procedures
(This will inform you how fire risks are managed and what to do
in an evacuation)
-Alerteverybodyinthe flat,leavethe
room at once and close the door.
-Go to designatedassemblypoint
(GRASSEDVERGE AT THE FRONTCAR
PARK).
-Call fire services(999).
-AlertCarrMillsoffice if they’re not
alreadyaware.
 Periodic/Fixed Electrical Testing
Certificates
(These ensure that the electricalsystems are safe to use in a
building)
N/A (All electricaloutletsare regularly
tested).
 Venue Sound Level risk assessment –
music
(A venue may have a policy or risk assessment for sound level
control, ensuring it does not exceed levels where it has the
potentialto cause damage to hearing?)
N/A
 Public Liability Insurance
(All public venues are required to have public liability
insurance, to ensure theyare covered should an incident occur)
N/A

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Description of the shoot – Include all details such as the schedule, equipment to be
used, any props, main safety precautions, type of shoot, activities, transport, any
external contributors, chemicals etc.
Taking place in my flat, we will be shooting over three days. All crew live nearby but a
taxi may be used for the transport of kit. All flatmates will be made aware of the
proceedings.
Schedule
Wednesday 28th
April 2021
 Meet at the flat at 9:00am and set up the location.
 Begin filming at 10:00am.
 Lunch at 1:00pm.
 Resume at 1:45pm.
 Pack up at 5:00pm.
Thursday 29thth
May 2021
 Meet at the flat at 9:00am and set up the location.
 Begin filming at 10:00am.
 Lunch at 1:00pm.
 Resume at 1:45pm.
 Pack up at 5:00pm.
Friday 30th
April 2021
 Meet at the flat at 9:00am
 Start pick ups at 10:00am.
 Pack up and wrap when finished.
Kit
16, 24, 35, 50 and 80mm XEEN lenses.
2x 128gb SD cards.
2x Arri lighting stands.
Blackmagic monitor.
Clapperboard.
D-tap cable.
EVA-1 camera.
Extension lead.
Follow focus.
Manfrotto Tripod.
Teradek transmitter and receiver.
2x Kino lights.
Light Reflector.
Rode boom pole.
Sennheiser shotgun microphone.
Steadicam.
V-Lock batteries.
Zoom F8N Audio Recorder.
 Asbestos Risk Assessment/Report
(All propertiesbuilt up until 1992 have the potentialto contain
asbestos materials, even accidentaldamage to these materials
can be hazardous. Mostvenuesof this age will have had
asbestos surveys undertaken and will have reports which give
information about how asbestos is managed if present. It is
important you know this before installing an exhibition in a
venue.)
N/A

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Props and costume
Clock,
Poster,
Sandwiches,
Tomato,
White Shirts,
Black ties,
Black shoes,
Black trousers.
Button.
Identifying, evaluating, controlling and rating risk
Risk Rating Guidance
Severity of potential risk Likelihood of potential risk
High
 Hazards capable of resulting in death,
severe injury, disability or serious illness
 High cost both to individualand
organisation
3
High
 Likely to occur at any time during the
shoot 3
Medium
 Hazard capable of resulting in moderate
personalinjury/illness/damage/loss
capability
2
Medium
 May occur during the shoot 2
Low
 Hazard resulting in minor injury requiring
first aid treatment
 A minor loss event to the individualor
the organisation
1
Low
 Unlikely to occur
1
The risk rating guidance above should be used to assist you in determining the severity of
the potential risk and likelihood of potential risk of hazards. In the table below tick the
items that you believe are potential hazards (any not listed put in ‘other hazards’).
Having identified the hazards, you then have to consider how likely it is that harm will occur
and to who; i.e. the level of risk and what to do about it. Risk is a part of everyday life and
you are not expected to eliminate all risks. What you must do is make sure you know about
the main risks and the things you need to do to manage them responsibly.
The risk rating guidance above should be used to assist you in determining the severity of
the potential risk and likelihood of potential risk in the table below.
When you allocate the rating you do so after taking into consideration any measures – called
control measures - that you have/or will put in place to reduce the risks.

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Potential
hazards or
hazardous
activity
(please tick)
Who may be
affected¹ and
how?²
Action taken to remove, reduce
or control risks
Severity
of
potential
risk
Likelihood
of
potential
risk
Access/ Egress □
(obstructions, doors &
access routes)
Some doors may
make moving
equipment
tricky between
takes.
All shooting in one location where
equipment is already being stored.
1 1
Animals/reptiles/
birds □
N/A N/A N/A N/A
Audience/
members of the
public □
Other flat
mates may be
around at time
of shoot.
Alert the flatmates and give them
plenty of time to use the facilities
in the kitchen.
1 1
Chemicals or
substances
hazardous to
health □
(e.g. compressed air,
dust, sand, fake blood
etc)
N/A No hazardous substances or
chemicals will be used during the
shoot.
2 1
Confined spaces
□
Working indoors
around
equipment. Risk
of tripping
cables/
Equipment.
Cables will be taped down and
clearly marked; rooms aren’t too
small so there is still enough room
to manoeuvre.
2 1
Cranes, hoists,
lifts & access
platforms □
N/A Cranes/hoists will not be used on
this set.
2 1
Dangerous
structures □
N/A Working indoors in a building of
structurally integral building.
3 1
Drones & aerial
cameras □
N/A Working indoors, drones/aerial
cams will not be used on this
shoot.
2 1
Electrical □ Crew will be
using filming
equipment, risk
of
electrocution.
The equipment supplied by the
university is tested regularly (all
passed their electrical test).
3 1
Falling objects □
Lights placed on
stands, could be
knocked over
onto cast and
crew members.
All cables will be taped down and
secured, with lighting stands being
properly set up for use.
2 1
Fire or heat □ N/A No open flames being used in the
production.
N/A N/A

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Food & drink
(e.g.allergens) □
Cast and crew
will be asked to
bring along
their own lunch.
Cast and crew will also be made
aware of the food being used in
the film in case of possible
allergies (adjustments will be
made depending on the situation).
3 1
Heat/cold □ N/A Shoot will take place indoors.
Temperate.
N/A N/A
Lighting &
visibility □
(e.g.reduced light, fog,
smoke)
N/A Working indoors in a well-lit
environment, all fire guidance
signs are glow in the dark in case
of power outage.
N/A N/A
Lone working □ N/A Working with a crew of four. 1 1
Manual Handling
(e.g. lifting and
carrying)□
Equipment will
be needed to be
moved around
in between
takes. Risk of
injury.
Not having to move the equipment
very far, only between rooms.
2 1
Noise □
(e.g. loud machinery,
music, address systems)
Sound from
other buildings.
Fire alarm test Wednesday at
13:00. Doesn’t disrupt the shoot.
1 1
People at higher
risk □
(e.g.pregnant women,
infants/children,
elderly, vulnerable
persons, known medical
conditions of any
participants)
N/A Masks will be worn by crew at all
times.
3 1
Props &
equipment □
Expensive and
heavy
equipment
could be
knocked over.
Stands and tripods will be properly
set up, cables will be taped down
and clearly marked to avoid any
trip hazards.
2 1
Security/ Theft □ Equipment
could be stolen.
Equipment to be locked in the
store room when out of use.
3 1
Slip, trip or fall □ Cast and crew
members could
trip over,
injuring
themselves.
Shooting indoors where the floor
surface is flat. Cables could be
tripped over however these will be
organised and taped down.
2 1
Stunts &
hazardous
activities □
(including being near
vehicles)
N/A N/A N/A N/A
Special effects □
e.g. fireworks,
pyrotechnics
N/A N/A N/A N/A

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Violence,
aggression (realor
simulated) □
N/A N/A N/A N/A
Working in/near
water □
N/A N/A N/A N/A
Working at
heights □
N/A N/A N/A N/A
Other hazards
not listed above
N/A N/A N/A N/A
1
E.g. staff, student, member of the public
2
E.g. cuts, bruises, fractures, electric shock, burns, allergic reactions
Overall Risk Rating
Having identified and assessed the risks above, use the table below to consider an overall
rating for the activity on the basis of the severity and likelihood of it leading to severe injury
or severe impact on the health of anyone involved.
Tick next to the risk level
Severity:
With control measures in place
what is the potential severity of an
injury or health effect?
Low
1
Medium
2
High
3
Likelihood:
How likely is the most significant
hazard to cause harm?
Low
1
Medium
2
High
3
Total risk score:
(severity multiplied by likelihood)
Low
1-2
Medium
3-4
High
6-9
Is the shoot of a sensitive nature or likely
to cause offense to the beliefs or values of
others?
(Information may need to be given to involved parties or
audiences, advice can be soughtfromthe Module Leader
or Course Leader)
The shoot does not cover anything of a
sensitive nature that could cause offence
to someone’s beliefs or values.
Declaration
Name: Gabriel Kelly
Date: 21/04/21
This form should be emailed to the Module Leader who will need to consult and seek
approval from the members of staff detailed below where the risk is medium/high. Students
should not carry out any further work until this risk assessment has been approved.
Staff Authorisation

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The staff below are confirming they have read and understood this risk assessment, and
where necessary discussed further with the student prior to authorising. It is noted that
the control measures are considered appropriate unless additional controls are
identified in the box below.
Position Risk Name and Signature Date
Module Leader Low
Course Leader Medium
Programme Director High
Estates (Risk & Safety) High
Additional control measures required by any of the above named?
How will you ensure your shoot is Covid secure?
Prior to filming, all cast and crew will be required to have a lateral flow test from the
test site at Leeds Arts University. On set all Crew members will be required to wear face
coverings and cast members will also be required to wear one in between takes. As we
are shooting indoors windows will be kept open to allow for better ventilation and
circulation of air. Cast and crew members will also be required to keep a safe distance
from each other, however because we’re shooting inside this may become difficult at
times. All crew have also completed the Screen Skills covid safety certificate.
Once authorised, the member of staff should give this form to the HE Administrative
Assistants who will scan and file a copy in the course S Drive and email a copy to the student.
This form should be saved in the organisers name using the convention
initial.surname.dd.mm.yy.SAF (date of event).