SHOOT DATE/S:

PRODUCTION OFFICE PHONE/MOBILE:

LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location)

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

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

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

VU

30
31

Working at heights
Working overseas

32

Other risks

Calculate the Risk Factor:

Very Unlikely
Very severe
Severe
Moderate
Slight
Negligible

3
2
2
1
1

Decide the action to take:

5
Very severe
4
Severe
3
Moderate Risk
2
Low Risk
1
Negligible

Then list each risk identified

VU

Unlikely

Possible

Likely

Very Likely

4
3
2
2
1

4
3
3
2
2

5
3
3
3
2

5
5
3
3
3

Take immediate action

High priority
Programme for action
Action may be required
Probably acceptable

LOCATION RISK ASSESSMENT FORM

PRODUCTION TITLE:

Hazard no: 3
Description

Risk Factor (1-5)

Lanterns and sparklers used at dusk

Person(s) exposed (detail if

cast/crew (C), outside
company (O) or public (P) )
Action to take

Public wont be at risk because the beach isnt usually busy at this time, however
cast and crew will have to be careful.
Wear protective gloves, hair up and water nearby. Parents will be there if needed

Person/company responsible Ellyse Garwood

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)
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: Ellyse Garwood

Position: Director

Signature Ellyse Garwood

Date: 10/10/2014

Countersigned by:

PRODUCER

Signature

Date: