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RISK ASSESSMENT FORM

Name: Carlos Jordan Project: Untitled Music Video Dates of working off-campus: 31/4/2013 Equipment being used (if any): Camera, Tripod

Do you need to use this form? This form is an important part of planning any activity that takes place. If you intend to work on any academic or production activity off
campus, please fill out this form and discuss any risks with your tutor. In many cases, there will be no risks that can be identified and only SECTIONS A and C will need to be completed. Where there are risks SECTION B must be completed. Only forms completed to a satisfactory standard and signed by your tutor will be accepted. Please remember that you may not be allowed to proceed with your off-campus activity if this form is not completed.

Section A
A number of potential hazards associated with working off campus are listed below. Examine each in the light of your activity and tick yes or no.

Y 1 2 3 4 5 6 7 8 9 Lone working Cabling Hoists Lighting Explosives/pyrotechnics Smoke Effects Working in poor visibility Scaffolds Working at heights
Y Y

N 10
N N N N N

Y Working in/near water Beach/Sand Vehicles /Traffic Aircraft Animals Props Costumes Glass Electrical Cables/ Pylons
Y Y

N
N N

Y 19 20 21 Caves/tunnel/quarries Stunts Fight sequences Violent interviewees Actors/Performers Child performers Drug Users Criminals Guns/Firearms
Y Y Y Y

N
N

11 12 13 14 15 16

N N

22 23 24

N

N N

N N N

25 26 27

N N

17 18

N

28. Use this space to detail any other potential hazards associated with your assignment

Section B* If you ticked any “Y” boxes in Section A, then please complete Section B. Hazard no: 15 Risk – give further details. I.e. there is a risk that... The only potential risk I had was pieces of plastic, metal etc. flying off the laptop when it is hit, but I have sorted a solution to avoid this. Control – what are you doing to minimise the risk? I am filming in my house/garden so there shouldnt be any risk to minimise. Communication – what efforts are you making to communicate the risk to members of the team, the general public etc? I am not filming where there are any members of the public. Hazard no: 12 Risk – give further details. I.e. there is a risk that... I plan on using a car during filming, but I cant drive. So there’s various possibilities of what could happen if something when wrong Control – what are you doing to minimise the risk? Spending as little time on the road as possible. Communication – what efforts are you making to communicate the risk to members of the team, the general public etc? Will put up a sign to warn members of the public. Section C The following students are working on this project: Carlos Jordan To the best of my belief the information given is correct and complete Signed (STUDENT) __________________________________________________________ Date: _______ / ________ / ________
* Please complete Risk Assessment Continuation sheets if additional space is required.

Based on the information supplied, I hereby authorise this activity: Signed (TUTOR) ___________________________________________________________ Date: _______ / ________ / ________