SHOOT DATE/S:

PRODUCTION OFFICE PHONE/MOBILE:

LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location)

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

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:

Hazard no:2
Description

Risk Factor (1-5) 3

As we will be filming outside there will be risk of nearby animals and insects
interrupting the filming

Person(s) exposed (detail if

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

C
I will have my assistant director check that the shot is free from animals and try to
shut down the situation

Person/company responsible Assistant director

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

Risk removed? (y/n)

Hazard no:11
Description

Risk Factor (1-5) 3

The weather could be extreme and prevent filming and cause injury

Person(s) exposed (detail if

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

I will check the forecast before and on the morning of filming if it is raining or too
windy I will cancel filming and reschedule

Person/company responsible Director (aka me)

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

Risk removed? (y/n)

Hazard no18
Description

Risk Factor (1-5) 3

The public has access to where we will be filming so there might be problem with
people entering the shot or putting the public into danger.

Person(s) exposed (detail if

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

P/C
My Assistant director will make sure that the path way is clear and that nobody is
harmed.

Person/company responsible Assistant Director

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

Risk removed? (y/n)

Copy and paste this table for each of the hazards, then get the form signed. If the producer has not completed
the risk assessment, then they should countersign this form.
Completed by: Amelia Hart

Position: Director

Signature Amelia Hart

Date: 07/10/2014

Countersigned by: Gillian Edwards

PRODUCER

Signature Gillian Edwards

Date:07/10/2014