RISK ASSESSMENT FORM

Name: Pooya Alipoor Project: Sci-Fi Drama Dates of working off-campus.. Equipment being used (if any)

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 Y Y

N
N

Y 10 11 Working in/near water Beach/Sand Vehicles /Traffic Aircraft Animals Props Costumes Glass Electrical Cables/ Pylons
Y 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

N
N N N N

12 13

N N

22 23 24 25

14 15

N N N

N N N

16 17 18

N N

26 27

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: Risk give further details. ie there is a risk that... We are going to shoot the first sense in a car park. Control what are you doing to minimise the risk? So I have to make sure it is safe for the actors Communication what efforts are you making to communicate the risk to members of the team, the general public etc? Have team meeting before we start shooting and warn every member of the team. Hazard no: Risk give further details. ie there is a risk that... We are going to use lights and maybe also use smoke effects. Control what are you doing to minimise the risk? I have to double check before filming and make sure there isnt any danger Communication what efforts are you making to communicate the risk to members of the team, the general public etc? I will have group meeting with the members of the team and tell them about the health and safety.

Section C The following students are working on this project: Vitaly, Christina, Pooya, Bhishma and Will To the best of my belief the information given is correct and complete Signed (STUDENT) __________________________________________________________ Based on the information supplied, I hereby authorise this activity: Signed (TUTOR) ___________________________________________________________

Date: _______ / ________ / ________

* Please complete Risk Assessment Continuation sheets if additional space is required.

Date: _______ / ________ / ________