Risk Assessment Form Part A

Production Name: Interlude Book Trailer Organisation

Production Address: 66 Springfields Producer / Editor Megan E Telford

Wigton Tel: 01697 508301
Cumbria Mobile: 07577 038335
CA7 9JS

Start date 28/06/2017 End date 28/06/2017

Distribution Megan E. Telford,

Who gets a copy of the assessment

Outline of risk assessment In this assessment I have outlined the risks of one of the locations I will be using to shoot my visual and the
Summary of what is proposed in risks of the equipment we will be using and how we will ensure that everyone is safe while on set.
terms of sequences and set ups.

Team members / experts / contrac-

tors / contributors etc. Megan E Telford,
List those involved

Locations 66 Springfields
Wigton
Outline locations involved indicate Cumbria
any which are hostile environments CA7 9JS

Assessor Name Date completed DD/MM/YYYY

Signature

Authoriser Name Date authorised DD/MM/YYYY

(if not Assessor) Signature

Hazard list select your hazards from the list below and use these to complete Part B

Situational hazards Tick Physical / chemical hazards Tick Health hazards Tick

Assault by person Contact with cold liquid / vapour Disease causative agent

Attack by animal Contact with cold surface Infection

Breathing compressed gas Contact with hot liquid / vapour Allergic reaction

Cold environment Contact with hot surface Lack of food / water

Crush by load Electric shock Lack of oxygen

Drowning Explosive blast Physical fatigue

Entanglement in moving machinery Explosive release of stored pressure Repetitive action

High atmospheric pressure Fire Static body posture /

Hot environment Hazardous substance Stress / anxiety /

Manual handling / Ionizing radiation Venom poisoning

Object falling, moving or flying Laser light

Obstruction / exposed feature Lightning strike Environmental hazards

Sharp object / material Noise Litter

Shot by firearm Non-ionizing radiation Nuisance noise / vibration

Slippery surface Stroboscopic light Physical damage

Trap in moving machinery Vibration Waste substance released into air

Trip hazard / Waste substance released into soil / water

Vehicle impact / collision Managerial / organisational hazards

Falls from height Management factors (lack of communication, co-

operation, co-ordination and competence)

Risk matrix use this to determine risk for

each hazard i.e. how bad and how likely Likelihood of Harm

Remote Very unlikely Unlikely Possible Likely

Severity of Harm e.g. <1 in 1000 chance e.g. 1 in 200 chance e.g. 1 in 50 chance e.g. 1 in 10 chance e.g. >1 in 3 chance

Negligible e.g. small bruise Trivial Trivial Trivial Low Low

Slight e.g. small cut, deep bruise Trivial Trivial Low Low Medium

Moderate e.g. deep cut, torn muscle Trivial Low Medium Medium High

Severe e.g. fracture, loss of consciousness Low Medium High High Extremely high

Very Severe e.g. death, permanent disability Low Medium High Extremely high Extremely high
 Risk Assessment Form Part B

Activity1 Camera Work, boom pole/mic operation, acting. Location 66 Springfields, Wigton, Cumbria, CA7 9JS

Hazards2 Who exposed Risk3 Control measures

List what could cause harm from
this activity
e.g. falls from height, trip hazard,
fire, etc.
List who might be For each hazard, de- For each hazard, list the measures you will be taking to minimise the risk iden-
harmed from this ac- cide level of risk as if tified
tivity you were to do the e.g. appointing competent persons, training received, planning and rehearsals,
e.g. staff, contrac- activity without your use of personal protective equipment, provision of first aid, etc.
tors, contributors, controls
public, etc.

Manual Handling Contributors, Low I will be sure only to carry the equipment I am sure I can manage at
crew. a time and should I need help, I will ask for it.

Trip Hazard Contributors, Low I will clear the filming area of all clutter and make sure all surround-
crew. ing wires are organised and out of the way.

Static Body Posture Contributors, Low I will be sure to take breaks and walk around a bit every so often to
crew. avoid any damage to my posture if I have been sat filming for a long
time.

Stress/Anxiety Contributors, Low I will be creating a storyboard of what shots I need to get and a script
crew. for what I need to say for the voiceover, hopefully since I have
planned ahead this shoot should go off without a hitch.

Continue on separate sheet if necessary

1 complete separate table for each activity 2 - from hazard list in Part A 3 - from risk matrix in Part A