SHOOT DATE/S: 26/10/2015

PRODUCTION OFFICE PHONE/MOBILE: 07539550751

LOCATION THIS FORM RELATES TO: 30 Ella Road

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?

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

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

Severity

Likelihood

Risk Factor

Yes

Yes

VU

Yes

Yes

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: Dapa Deep Mine (Radio Edit) music video

Hazard no: 8
Description

Risk Factor (1-5)

3
Filming might take long hours, especially because filming will be between 6pm and
10pm.

Person(s) exposed (detail if

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

C
Have regular breaks for food, tea and relaxing so crew would not get too tired.

Person/company responsible Myself

for action
To be completed at agreed later date Exposed person(s)
Agreed action taken? (y/n)
informed? (y/n)

Completed by: Evelina Vysniauskaite

Position: Director

Signature: Evelina Vysniauskaite

Date: 25/10/2015

Countersigned by: Evelina Vysniauskaite

Signature: Evelina Vysniauskaite

PRODUCER
Date: 25/10/2015

Risk removed? (y/n)