SHOOT DATE/S: 11th, 18th, 25th, 26th, 28th October / 1st, 8th, 9th November.

PRODUCTION OFFICE PHONE/MOBILE: 07596374327.

LOCATION THIS FORM RELATES TO: Jerry march Funeral Directors.

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

VU

VU

/
/

L
L

VU
VU

1
1

VU

VU

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

Risk Factor

LOCATION RISK ASSESSMENT FORM

PRODUCTION TITLE: Music Video.

Hazard no:
Description

2
I have dogs and cats.

Risk Factor (1-5)

Person(s) exposed (detail if

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

C, my crew are exposed to these.

None needed, though I could let them out into the garden during filming, or keep
them indoors.

Person/company responsible Myself.

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

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

Risk removed? (y/n)

9
Risk Factor (1-5)
1
We will be filming in woodland space, so the trees are obviously flammable and so
there is a small risk, though there will be no fire used, and there has never been a
fire there before.
C, the crew would be exposed should this happen.
None needed, though I could be careful not to let equipment malfunction, as well as
cleaning up glass, bottles and containers before leaving set.

Person/company responsible Myself.

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

Risk removed? (y/n)

Hazard no:
Description

17
Risk Factor (1-5)
1
I will be handling the camera at all times with an attachment to my helmet.

Person(s) exposed (detail if

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

Myself.
None needed, not dangerous.

Person/company responsible Myself.

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

Risk removed? (y/n)

Hazard no:
Description

18
Risk Factor (1-5)
There may be spectators and crowds, as well as traffic.

Person(s) exposed (detail if

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

Crew and myself.

None needed, not dangerous.

Person/company responsible Myself.

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

Risk removed? (y/n)

Hazard no:
Description

27
Risk Factor (1-5)
1
There will be scenes where I, and a friend, are biking around.

Person(s) exposed (detail if

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

He and I.
Drive safely and we should be fine, plus we arent using busy roads.

Person/company responsible Myself.

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

Risk removed? (y/n)

Hazard no:
Description

28
Risk Factor (1-5)
1
I will be using water in the video, in the form of a swimming pool and bath.

Person(s) exposed (detail if

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

Myself.
None needed, not dangerous, though I could make sure that someone is there with
me for safety.

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: Brandon march

Position: Director

Signature

Date: 9/10/2014

Countersigned by:

PRODUCER

Signature

Date:

Risk removed? (y/n)