LOCATION RISK ASSESSMENT FORM

PRODUCTION TITLE: ‘Experimental Impressions’ – Promotional Video PRODUCTION OFFICE PHONE/MOBILE: 07786524362 LOCATION THIS FORM RELATES TO: North Walsham

SHOOT DATE/S: 29/04/13

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

Calculate the Risk Factor:
Very severe Severe Moderate Slight Negligible Very Unlikely 3 2 2 1 1 Unlikely 4 3 2 2 1 Possible 4 3 3 2 2 Likely 5 3 3 3 2 Very Likely 5 5 3 3 3

Decide the action to take: 5 Very severe 4 Severe 3 Moderate Risk 2 Low Risk 1 Negligible

Take immediate action High priority Programme for action Action may be required Probably acceptable

Then list each risk identified

Hazard no:21 Description Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) ) Action to take

Risk Factor (1-5) Smoking on set My client and I

2

To smoke either after or before shooting and to keep distant from the public

Person/company responsible My client and I for action To be completed at agreed later date Exposed person(s) Y Agreed action taken? (y/n) Y informed? (y/n) Hazard no:5 Risk Factor (1-5) Description Confined Spaces Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) ) Action to take My client and I

Risk removed? (y/n) 3

To removed anything in the bedroom which could be in the way on filming

Person/company responsible My client and I for action To be completed at agreed later date Exposed person(s) Y Agreed action taken? (y/n) informed? (y/n)

Y

Risk removed? (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: ZM Editor Signature Position: Director, Producer, Camera Operator, & Date: 11/04/13

Countersigned by: Signature

PRODUCER Date:

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