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12. APPENDICES
EI EI EI General Risk Assessment Form
- Part A
Apnl 2AA7- DC
Division / Studio
W*'Mn p/,t'en Department / Series
lMctBusines Unit / Produc-tion
Address flt' rt/rrts' Producer / Editor
Tel:
Mobile:
C&n l4-trk
Period covered by assessment Version number
P,,non| &wc o @rfiobr
Team members / experts /
contractore / etc.
List those involved
$1cn ryla"
Site/Office/Location
Outline site/ l@ations involved }chool cor
Assessor Name
Signature
Date completed
Authoriser
(if not Assessor)
Name
Signature
Date authorised
Hazard list - seiect your hazatds trcm the tist below and use these to complete Part B (add othes where apprcpiate)
Situational hazards Tick Physical / chemical hazards Tick Health hazards Tick
Asbestos Contad with cold liquid / vapour Disease @usative agent
Assault by person Contact with cold surface lnfection
Attacked by animal Contad wilh hot liquid / vapour Lack offood / water
Breathing compressed gas Conlact with hot surface Lack of oxygen
Cold environment Electric shock Physical fatigue
Crush by load Explosive blast Repetitive action
Drowning Explosive release of stored pressure Statrc body posture
Entanglement in moving machinery Fire
Hot envkonment Hazardous substance
lntimidation lonizing.adiation
Lifting Equipment Laser light Environmental hazards
l{anual handling Lighlning strike Litter
Objecl falling, moving or flying Noise Nuisance noise /vibration
Obstruction / exposed feature Non-ionizing radiation Physical damage
Sharp object / material Stroboscopic light Wasle substance released into air
Slippery surface t,/ Vibration Waste substance released into soil /water
Trap in moving machinery
Trip hazard Other
Vehicle impact/ collision
Working at height
RiSk matfix- rse this to.leternine isk fot
each hazarcl i.e. 'how bad and how likely' Likelihood of Harm
Severity of Harm
Remote
e.g. <1 in 1000 chance
Unlikely
e.g. 1 in 200 chan@
Possible
e.9. 1 in 50 chance
Likely
e.g. 1 in 10 chance
Probable
e.g. >1 in 3 chance
Negligible e.g. small bruise
Slight e.g. small cut, cleep bruise Medium
Moderate e.g. deep cut, torn muscle Medium Medium
Severe e.g. ,iacaure, ,oss ofcorsoiolsress Medi0m Ext,emely high
Very Severe e-g. death, permanent disability Medium Extemely high Extremely high
NUJ Commission on multi-media working 2007 53
B.HEALTH AND SAFETY:
THE BBC RISK ASSESSI4ENT FORIVI
Outline of risk assessment
Sunmary of what is prcposed
Stress
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14. Special Effects Make-up Test
Test performed by:
Performers Name:
Date:
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Has the performer got any known skin conditions or allergies? (lf yes please detail)
Test make-up on the inside of the arm by the wrist. Leave the make-up you are testing on for
approximately 1 min. lf any irritation, itching or burning occurs, remove make-up and clean the
area at a sink. Remember to make a note of any reactions next to the product that caused it.
Product Reaction (Tick or cross) Details/Notes
Derma Wax
Face-paint
Blood
Cream
Make-up wipes/remover
Other (Fill in product)
Performer Signature
Fixing/Transparrent Powder
Latex
Student Signature:
>{
A
'"
15. Special Effects Make-up Test
Test performed by:
Performers Name:
Date:
Has the performer got any known skin conditions or allergies? (lf yes please detail)
- Test make-up on the inside of the arm by the wrist. Leave the make-up you are testing on for
approximately 1 min. lf any irritation, itching or burning occurs, remove make-up and clean the
area at a sink. Remember to make a note of any reactions next to the product that caused it.
Product Reaction (Tick or cross) Details/Notes
Derma Wax
Face-paint
Blood
Cream
Fixing/Transparrent Powder
Make-up wipes/remover
Other (Fill in product)
Student Signature:
Performer Signature
d.
F-'
E*''
l4.
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16. ("the Project")PROJECT TITLE
DESCRIPTION OF CONTRIBUTION
DATE OF FILMING/CONTRIBUTION
NAME OF PRODUCTION COMPANY/ORGANISATION RUNNING THE PROJECT
_("the Company")
NAIUE OF CONTRIBUTOR
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ADDRESS OF CONTRIBUTOR
-!tta, r Li l ,".; .,&€d9/-{'$r "*'-, t,tr ta s - r^r al,.-t I d.ii:,r r-"a &..4.+e..1
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TELEPHONE NUMBER OF CONTRIBUTOR
ln consideration of the Company agreeing that I contribute to and participate in the Project,
the nature and the content of which has been fully explained to me, I hereby consent to the
filming and recording of my contribution to and participation in the Project subject to the
terms and conditions specified below. '
Signed by Contributor
Dated
CONTRIBUTORS RELEASE FORM
17. CONTRIBUTORS RELEASE FORM
hb e Project")PROJECT TITLE
DESCRIPTION OF CONTRIBUTION
tvc.rin Adpn
DATE OF FILMING/CONTRIBUTION
a,q /oq /17
NAME OF PRODUCTION COMPANY/ORGANISATION RUNNING THE PROJECT
Hed?h fb ("the Company")
NAIUE OF CONTRIBUTOR
RESS OF CONTRIBUTOR
Y'
TELEPHONE NUMBER OF CONTRIBUTOR
tilr'*r?req, eY{i
ln consideration of the Company agreeing that I contribute to and participate in the Project,
the nature and the content of which has been fully explained to me, I hereby consent to the
filming and recording of my conffibution to and participation in the Project subject to the
terms and conditions specified below. '
Signed by Contributor
Dated
I
:!^ ; ! { ! *,
'r1"Jr4:G
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18. Project")PROJECT TITLE
,r,bfe L4/OIF
DATE OF FILMING/CONTRIBUTION
eq lccai ( 7
e Company")
NAME OF CONTRIBUTOR
t-Jl
ADDRESS OF CONTRIBUTOR
ro Ar:e.tt t-q-
TELEPHONE NUMBER OF CONTRIBUTOR
L ,/ ,. , " t')' i1r 1Cq
ln consideration of the Company agreeing that I contribute to and participate in the Project,
the nature and the content of which has been fully explained to me, I hereby consent to the
filming and recording of my contribution to and participation in the Project subject to the
terms and conditions specified below. .
Signed by Contributor
Dated
CONTRIBUTORS RELEASE FORM
h
DESCRIPTION OF CONTRIBUTION
NAME OF PRODUCTION COMPANY/ORGANISATION RUNNING THE PROJECT
19. APPENDICES
EIEIEI General Risk Assessment Form
- Part A
Aptil 2007- DC
lqslb,btpn f{et*Iu Department / Series
/VlerJruBusiness unit / Production
Address
tt P frln Producer / Editor
Tel:
Mobile:
€aitn /nd#er-
Period covered by assesment Vereion number
Outline of risk assessment
Summary of what is proposed filwgt ra rbfraen<z@wn
Team members / experts /
contraclors / etc,
List those involved
fryan kyrre-
Site/Omce/Location
Outline sitd lrcations involved Green kreen Rccrn
A$essor Name
Signature
Authoriser Name
(if not Assessor) Signature
Hazard list - seimt you hazards from the list betow and use these to complete Paft B (add othes where apprcpriate)
Situational hazards Tick Physical / chemical hazards Tick Health hazards Tick
Asbestos Contact with cold liquid / vapour Disease €usative agent
Assault by pe6on Contact with cold surface I nfection
Attacked by animal Contact with hot liquid / vapour Lack oflood /water
Breathing compressed gas Contacl with hot surface Lack of oxygen
Cold environmenl Electric shock Physical fatigue
Cesh by load Explosive blast Repeti ve action
Drowning Explosive release of slored pressure Static body posture
Entanglement in moving machinery Fire St,ess
Hot environment Hazardous substance
lntimidation lonizing mdiation
Lifting Equipment Laser Iight Environmental hazards
Manual handling Lightning strike Litler
Object falling, moving or flying Noise Nuisance noise / vibration
Obstruction / exposed feature Non-iooizing radiation Physical damage
Sharp object / material Stroboscopic light Waste substance released into air
Slippery surface Vibration Waste substance released into soil /water
Trap in moving machinery
T.ip haz6rd Other
Vehicle impact / collision
Working at height
RiSk matfiX- rse this to cletetmine ,sk for
each hazarc! i-e- 'how bad and how likely' Likelihood of Harm
Severity of Harm
Remote
e.g. <1 in 1000 chance
Unllkely
e.g. 1 in 200 chan@
Possible
e-9. 1 in 50 chance
Likely
e.g. 1 in 10 chance
Probable
e.9. >1 in 3 chance
Negligible e.9. small btuise
Slight e.g. small cut, deep btuise Medaum
Moderate e.g deep cut, tom muscla Medium Medium
Severe e.g. li.acaure, /oss ofconsciousress lVedium Extremely high
Very Severe e.g- death, Wrmanent disability Medium Enrcmely high Enremely high
NUJ Commission on multi-media working 2007 53
B.HEALTH AND.SAFETY:
TH E BBC RISK ASSESSAI ENT FORNI
Division / Studio
Date completed
Date authorised
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21. 2
3
Terms and Conditions
I hereby agree that the copyright (if any) and all other rights title and interest in
and in respect of my contribution shall vest in and is hereby assigned to the
Company (and this assignment shall operate to the extent necessary as a
present assignment of future copyright) and that the Company shall have the
unfettered right to deal with the Project containing such contribution or any part of
it in any way that it thinks fit. Accordingly I agree that the Project incorporating
my contribution or any part of it m-ay be exhibited or otherwise however exploited
(and such exploitation may include the exploitation of ancillary rights therein) in
all media and formats throughout the universe for the full period of copyright and
all renewals and extensions thereof and thereafter so far as may be possible in
perpetuity
I hereby waive any so-called "moral rights of authors" in the Project and such
rights under section 77 and section 80 of the Copyright Designs and Patents Act
1988 as I now have or hereafter acquire in relation to the Project.
The Company may without my further consent use my name likeness biography
photographs of me and recordings of interviews with me in advertising and
publicising the Project in all media and formats throughout the universe
The Company shall not be liable to me or my legal representatives for any loss or
damage or injury to me or my property caused or suffered in connection with the
Company's making of the proposed Project unless caused by the negligence of
the Company and recoverable on that ground
I agree that the contribution shall not contain anything which is an infringement of
copyright or which is calculated to bring Heath Park Productions into disrepute or
which is defamatory provided however that the Company shall not be entitled to
bring claim against me in respect of any defamatory material that was included in
my contribution without negligence or malice on my part.
I hereby confirm that the terms of this agreement have been explained to me and
that I understand them.
The Courts of England shall have sole jurisdiction in relation to the terms and
conditions of the agreement contained in this release which shall be interpreted
according to the laws of England.
5
6
7
1
4.
