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SHOOT DATE/S:20th October

PRODUCTION OFFICE PHONE/MOBILE: 07881364693 LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location) Wymondham, Norfolk 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

No Yes

3 4

Audiences Camera cable/grip equipment

Yes No

5 6

Confined spaces Derelict buildings/dangerous structures

No No

7 8 9

Electricity/gas (other than normal supplies) Fatigue/long hours Fire/flammable materials

No No No

10 11

Hazardous substances Heat/Cold/extreme weather

No No

12 13

Laser/strobe effects Machinery/industrial/ crane/hoist

No No

14 15

Materials - glass, non-fire retardant set materials Night operation

No No

16 17 18

Noise – high sound levels Non standard manual handling Public/crowds

No No No

19 20

Radiation Scaffold/Rostra

No No

21 22

Smoking on set Special effects/explosives

Yes No

23 24 25

Special needs (elderly, disabled, inexperienced) Specialised rescue/first aid Stunts, dangerous activities

No No No

26 27

Tall scenery/suspended ceilings Vehicles/speed

No Yes

28 29

Water/proximity to water Weapons

No No

30 31

Working at heights Working overseas

No No

32

Other risks

No

Severity

Likelihood

L

L

1

L

L

1

L

L

2

S

VL

4

Calculate the Risk Factor: Very severe Severe Moderate Slight Negligible

Very Unlikely

Unlikely

Possible

Likely

Very Likely

3 2 2 1 1

4 3 2 2 1

4 3 3 2 2

5 3 3 3 2

5 5 3 3 3

Decide the action to take: 5 Very severe 4 Severe 3 Moderate Risk 2 Low Risk 1 Negligible

Then list each risk identified

Take immediate action High priority Programme for action Action may be required Probably acceptable

Risk Factor

LOCATION RISK ASSESSMENT FORM

PRODUCTION TITLE: JEKK MUSIC VIDEO


Hazard no: Description

27 Wymondham Train station

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) ) Action to take

Sofia Dante

Risk Factor (1-5)

4

Film during times train is expected, Check train times

Person/company responsible Network Rail/ Director for action To be completed at agreed later date Exposed person(s) YES Agreed action taken? (y/n) informed? (y/n)

YES

Risk removed? (y/n)

Hazard no: Description

21 Risk Factor (1-5) Actors smoking during shooting break

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) ) Action to take

Sofia Dante India Tell actors to not smoke around areas that could catch fire.

Person/company responsible Actors/Director for action To be completed at agreed later date Exposed person(s) YES Agreed action taken? (y/n) informed? (y/n)

YES

YES

2

Risk removed? (y/n)

Hazard no: Description

2 Risk Factor (1-5) Animals/Wildlife in woodland areas

Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) ) Action to take

Sofia Dante India Advise them to be careful when walking around the location

YES

1

Person/company responsible Actors/ Directors for action To be completed at agreed later date Exposed person(s) YES Agreed action taken? (y/n) YES Risk removed? (y/n) YES informed? (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: Shane Reynolds

Position: Director

Signature Date: 18th October Countersigned by:

PRODUCER

Signature

Date:

Wymondham risk  
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