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

2. Hazard no:
Description
Person(s) exposed (detail if
cast/crew (C), outside
company (O) or public (P) )
Action to take
6
Risk Factor (1-5)
2
The building is not Derelict or dangerous but it is very old and we will be using
some of the structures around it as well but all have been labelled by the council
safe for use.
Cast and Crew: Myself, Dante, Jack, Luke Deano, Maisie and Ayden
Make sure no one is climbing on any of the structures and only go near those
approved by the council
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)
yes
Hazard no:
Description
15
Risk Factor (1-5)
We will be filming some shots at night
Person(s) exposed (detail if
cast/crew (C), outside
company (O) or public (P) )
Action to take
Risk removed? (y/n)
yes
3
Cast and Crew: Myself, Dante, Jack, Luke Deano
It is a well-lit area on public land. There are few if any risks. Although we have
agreed not to stray from the area we are using and to keep quiet so as not to disturb
others.
Myself
Person/company responsible
for action
To be completed at agreed later date Exposed person(s)
yes
Agreed action taken? (y/n)
informed? (y/n)
yes
Risk removed? (y/n)
yes
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)
yes
Risk removed? (y/n)
yes
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
Countersigned by: Sofia Morana
Signature
Position: Director
Date: 25/10/13
PRODUCER
Date: 25/10/2013