Risk Assessment Form Part B

Reference:
6 Sign-off status

ACTIVITIES: What are you doing, where, for how long and who will be HAZARDS & CONTROLS: How could someone become hurt or made ill and
involved? Complete the fields in the form below). how are you going to prevent this from happening?

Activity Title:* Deranged

Activity Description: TV drama filmed on location

List those managing Charlotte Creek, Director

this Activity and their
competence:

Who & how many are Charlotte Creek director and camera
at risk from this
Activity?

Hazards Control measures

How could someone become hurt or made ill How are you going to prevent this from happening?
Fire Because in my sequence there is going to be a fire, this could be a hazard as I may hit on by accident
and it could fall on me and hurt me as well as it could cause a fire and damage property that isnt mine.
To prevent this from happening I am going to be safe around the fire and no get too close to it to
prevent anything happening.

Falling off chair Some of my shots I have to get on a chair to film because I cant reach this is a safety hazard because I
could fall off. This is a hazard as the chair could break and hurt me or I fall off and hurt myself or even
someone else helping me. To prevent this I am going to have my mum hold the chair or me to make
sure I am stable and wont fall off and hurt myself.
Tripping on something Because Im filming in my house there could be something in the way that I could trip on while filming.
This could cause me to hurt myself or someone else. To prevent this I am going to make sure nothing is
in the way so I know I wont fall. Because I know the shots due to my storyboard I know where I need
to go so I know what I need to keep clear.

Wires Some of my shots involve a light which has a wire which I could potentially trip over. This is a hazard as
I may trip and hurt myself or it could fall on someone, burning them or hurting them. I am going to
make sure the wire is out of my way as well as it being under the carpet so I dont trip on it.

[* mandatory fields]
 Risk Level*: After your controls have been applied what is your assessment of the risk level of this Low
activity?

[* mandatory fields]