1. Risk Assessment Form – Part A
Reference:
Sign-off status
None required
Blank Template
[planning/approved etc]
Assessment summary details
Assessment title *
(Simple name for reference
purposes)
Division:*
If I were a boy music video
Department:*
Production
Series/ Prod/Unit:
Responsible Manager:
Programme/Area:
Thea de Chavez
11 Hamden Way
Address/Tel:
Media
Contact office:
Address/Tel:
CB23 3UG
Netherhall School and Sixthform
Centre
Queen Ediths Way
CB1 8NN
01223242931
Date assessment created
21/10/2013
Assessment Outline
(Summary of what is
proposed)
The filming of a music video, to check that the location is safe to use
Confidential risk
assessment?
NO
Assessment start date
28/10/13
Country location
England
Hostile / travel
advisory?
Location details
1 Collingwood Drive
Longstanton Cambridge
NB: If the country location selected is ‘Hostile’ you are
required to: complete the BBC Overseas High Risk
Assessment Form
Crew / team
(Roles, responsibilities,
competencies)
Review / End date
01/11/13
N/A
Thea de Chavez – Camerawork and Director
Attachments
(Detail supporting
documents)
Assessor(s)
*
Thea de Chavez
(Person drafting risk
assessment)
Authoriser(s) *
(Person responsible for
sign-off)
Distribution
(Who gets a copy of the
assessment)
Assessor safety
competence
Date signed-off *
Mr Sheppard
Production Crew
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
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
Filming on stair, park
Cast and Crew
Possibility of tripping and
falling
[* mandatory fields]
Activity Risk Rating
LOW

2. Risk Assessment Form – Part A
Blank Template
Comments log
Who by
Date / time
received
Comments
Assessor response
Date/ time
responded
Risk Assessment
Form – Part B
Reference:
[enter reference number]]
6
ACTIVITIES:
What are you doing, where, for how long and who will be involved?
Complete the fields in the form below).
Activity Title:*
Filming on stairs – someone might trip/fall
Park – They could hurt themselves
List those managing
this Activity and their
competence:
Director/camerawork – Thea de Chavez
Who & how many are at
risk from this Activity?
HAZARDS & CONTROLS:
How co
are you going to prevent this from ha
Filming on stairs and park
Activity Description:
Sign-off status
Cast and Crew – 4/5
Hazards
How could someone become hurt or made ill
Control meas
How are you going to prevent this from happening?
They could trip or fall down the stairs
Frequently check their steps and that the tripod isn’t in t
They could fall off the swing in the park or any park activities
Make sure that they are safe by telling them to be appro
case they cannot control it
Risk Level*: After your controls have been applied what is your assessment of the risk level of this
activity?
Add additional activities as required – by copying this section and pasting below
[* mandatory fields]
Low