This document is a location risk assessment form for a music video shoot taking place on 30 October 2013 at abandoned train tracks in Wymondham. It identifies smoking on set as a hazard with a risk factor of 3, as the cast and crew are smokers but have agreed to stand away from equipment and bystanders while smoking. The director Sofia Morana is responsible for ensuring this action is taken and those exposed are informed. The form was completed and signed by Sofia Morana as the director.

1. SHOOT DATE/S: 30/10/2013
PRODUCTION OFFICE PHONE/MOBILE: 07889030423
LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location) Wymondham Train Tracks (Abandoned)
Complete the following table rating
•
each risks severity on scale from Negligible (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)
•
Determine the risk factor from the table overleaf.
Hazard
Present?
1
2
Confined spaces
Derelict buildings/dangerous structures
7
8
9
Electricity/gas (other than normal supplies)
Fatigue/long hours
Fire/flammable materials
10
11
Hazardous substances
Heat/Cold/extreme weather
12
13
Laser/strobe effects
Machinery/industrial/ crane/hoist
14
15
Materials - glass, non-fire retardant set materials
Night operation
16
17
18
Noise – high sound levels
Non standard manual handling
Public/crowds
19
20
Radiation
Scaffold/Rostra
21
22
Smoking on set
Special effects/explosives
23
24
25
Special needs (elderly, disabled, inexperienced)
Specialised rescue/first aid
Stunts, dangerous activities
26
27
Tall scenery/suspended ceilings
Vehicles/speed
28
29
Water/proximity to water
Weapons
30
31
Working at heights
Working overseas
32
Other risks
Risk Factor
Audiences
Camera cable/grip equipment
5
6
Likelihood
Alcohol/drugs
Animals/insects
3
4
Severity
YES
L
VL
Calculate the Risk Factor:
Very Unlikely
Very severe
Severe
Moderate
Low
Negligible
Unlikely
Possible
Likely
Very Likely
3
2
2
1
1
4
3
2
2
1
4
3
3
2
2
5
3
3
3
2
5
5
3
3
3
Decide the action to take:
5
Very severe
4
Severe
3
Moderate Risk
2
Low Risk
1
Negligible
Then list each risk identified
Take immediate action
High priority
Programme for action
Action may be required
Probably acceptable
3
LOCATION RISK ASSESSMENT FORM
PRODUCTION TITLE: Inside My Head Music Video

2. Hazard no:
Description
21
Risk Factor (1-5)
3
The majority of my cast and crew smoke so there will be smoking on set
Person(s) exposed (detail if
cast/crew (C), outside
company (O) or public (P) )
Action to take
Cast and Crew: Myself, Dante, Jack, Luke Deano, Maisie and Ayden. Also some
members of the public might be exposed.
It is public land and outside, so completely legal to smoke, although my cast and
crew have agreed to stand away from the equipment, and any bystanders
Person/company responsible Myself
for action
To be completed at agreed later date Exposed person(s)
yes
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description
yes
Risk removed? (y/n)
Risk Factor (1-5)
Person(s) exposed (detail if
cast/crew (C), outside
company (O) or public (P) )
Action to take
Person/company responsible
for action
To be completed at agreed later date Exposed person(s)
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description
Risk removed? (y/n)
Risk Factor (1-5)
Person(s) exposed (detail if
cast/crew (C), outside
company (O) or public (P) )
Action to take
Person/company responsible
for action
To be completed at agreed later date Exposed person(s)
Agreed action taken? (y/n)
Risk removed? (y/n)
informed? (y/n)
Copy and paste this table for each of the hazards, then get the form signed. If the producer has not completed
the risk assessment, then they should countersign this form.
Completed by: Sofia Morana
Signature
Position: Director
Date: 25/10/13
Countersigned by: Sofia Morana
PRODUCER
Signature
Date: 25/10/2013
yes