This risk assessment form is for an advertisement for a fizzy drink company. It identifies potential hazards for performers doing sports stunts and crew handling technical equipment. Controls identified to manage risks include using protective gear, taping down loose wires, and having emergency services on standby. The overall risk level is assessed as medium after controls are applied.

1. Risk Assessment Form – Part A Blank Template
Reference: [enter reference number]] Sign-off status [planning/approved etc]
Assessment summary details
Assessment title * Fizzy drink Inc. Advert
(Simple name for reference
purposes)
Division:* Department:*
Series/ Prod/Unit: Programme/Area:
Responsible Gaius Milne Brown Contact office: Teletubby land
Manager:
Address/Tel: Cheadle Marple college Address/Tel: 0161 534 9879
Date assessment created 22/02/2013 Confidential risk NO
assessment?
Assessment Outline 30-60 second red eye energy drink advertisement
(Summary of what is
proposed)
Assessment start 22/02/2013 Review / End date 11/3/2013
date
Country location England Hostile / travel
advisory?
NB: If the country location selected is ‘Hostile’ you are
Location details
required to: complete the BBC Overseas High Risk
Assessment Form
Sophie: camera operator Sam: sound supervisor Tig: lighting technician
Crew / team
(Roles, responsibilities,
competencies)
Attachments
(Detail supporting
documents)
Assessor(s) * Assessor safety
(Person drafting risk competence
assessment)
Authoriser(s) * Date signed-off *
(Person responsible for
sign-off)
Distribution
(Who gets a copy of the 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
assessment) 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
Comments log
Who by Date / time Comments Assessor response Date/ time
received responded
[* mandatory fields]

2. Risk Assessment Form – Part B Blank Template
Reference:
6 [enter reference number]] Sign-off status [planning/approved etc]
ACTIVITIES: What are you doing, where, for how long and who will be HAZARDS & CONTROLS: How could someone become hurt or made ill and
involved? Complete the fields in the form below). how are you going to prevent this from happening?
Activity Title:* [activity 1 title]
Activity Description:
List those managing
this Activity and their
competence:
Who & how many are
at risk from this
Activity?
Hazards Control measures
How could someone become hurt or made ill How are you going to prevent this from happening?
Performers in the advert could fall and injure themselves when Make sure they are equipped with correct padding and protective gear e.g. helmet for skateboarders,
doing their specific sports. also make sure there is an ambulance on hand to treat anyone if they injure themselves.
With lots of high Tec equipment comes lots of wires. Members of Tape loose wires down to floor to make sure they do not become a hazard to members of the crew.
the crew could trip up and hurt themselves if loose wires are
about.
Risk Level*: After your controls have been applied what is your assessment of the risk level of High/Medium/Low (delete as applicable)
this activity?
Add additional activities as required – by copying this section and pasting below
[* mandatory fields]

3. Risk Assessment Form – Part B Blank Template
Reference:
6 [enter reference number]] Sign-off status [planning/approved etc]
ACTIVITIES: What are you doing, where, for how long and who will be HAZARDS & CONTROLS: How could someone become hurt or made ill and
involved? Complete the fields in the form below). how are you going to prevent this from happening?
Activity Title:* [activity 2 title]
Activity Description:
List those managing
this Activity and their
competence:
Who & how many are
at risk from this
Activity?
Hazards Control measures
How could someone become hurt or made ill How are you going to prevent this from happening?
[Hazard 1 title and description] [Details of control measures]
[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 High/Medium/Low (delete as applicable)
this activity?
Add additional activities as required – by copying this section and pasting below
[* mandatory fields]