PRODUCTION SAFETY FORM (forms to be completed and on hand at every shoot)

University of New South Wales and the School of Arts and Media recognises as a primary responsibility its statutory obligations for the safety and well being of
all its employees and students and other persons at locations where university/business is being carried out. In fulfilling this responsibility the university will
act, so far as is reasonably practicable, in accordance with Section 28, Workplace Health and Safety Act, 1995 to ensure the health, safety and welfare of all
persons, including persons not formally associated with the university.
Students need to safeguard, so far as is reasonably practical, their own health and safety and that of others.
The purpose of the following three forms is to help identify hazards and ensure appropriate steps are taken to minimise risks in order to protect the health and
safety of university employees and anyone connected with the production.
PRODUCTION NAME:Uncanny Visions of a Kaleidoscopic Mind
YEAR: 2016
FIRST AID/STUDENT SAFETY OFFICER: David Nguyen
SHOOTING COMENCING: April 10th 2016
LOCATIONS

66 Joyce St
Punchbowl

CAST AND CREW

NAMES

Louise Riley
Joel Maguire
David Nguyen
Chelsea Nelson
Phoebe Cook

GROUP NUMBER: Thursday 1:00pm 4pm

SUBJECTCODE: ARTS3061

SUPERVISING LECTURER: Greg. D

SHOOTING FINISHED: April 10th 2016

SHOOTING
DATES

CLOSEST HOSPITAL/ MEDICAL

CENTRE TO LOCATION

ADDRESS

PHONE

April 10th 2016

Bankstown Hospital - 68
Eldridge Rd, Bankstown
NSW 2200

66 Joyce St Punchbowl

0449 898 688 & 0405 733

751

CONTACT
DETAILS

0430289981
0433078507

0449898688
0430599904

Refused to Disclose

ANY KNOWN MEDICAL CONDITIONS

CONTACT PERSON AND THEIR CONTACT

DETAILS IN CASE OF AN EMERGENCY

N/A
N/A
N/A
N/A
N/A

Ani Reily - 0425207169 - Mother

Karen - 0416192581

Van Nguyen (Father) 0405 733 751

Roxane Nelson, 0418425032 - Mother

Refused to Disclose

VOLUNTEER FORM
submitted for NonGriffith participants?

N/A
N/A
N/A
N/A
N/A
N/A
N/A

HAZARD IDENTIFICATION/RISK ASSESSMENT

Hazards must be identified before filming commences. The list below acts as a prompt for hazards additional to those you have identified yourself. When
a hazard has been identified you must perform a risk assessment. The producer should assess whether the risk is high, medium or low, and take
appropriate action to minimise the level of risk. The Risk Reduction/Action Form will be a record of your risk management.
REMEMBER: The health & safety of production members and the public must be protected by the establishment of a safe & controlled working
i
t

HAZARD IDENTIFICATION

RISK ASSESSMENT

Tick if any of the categories are relevant

Nil

Locations and associated issues

Trip Hazard (Electrical wiring)
Fire Hazard (Use of candles)
Old architecture & property
Fatigue (Long hours)
Small/Confined spaces

Cars, Roads, Traffic

Driving to site

Human Factors
Manual Handling (Furniture)

HAZARD IDENTIFICATION
Tick if any of the categories are relevant

Low/Med

High

Other Activites, work processes, props

Electricity, Lights & Cables
Jib, Dolly, Crane
Stunts / fight scenes
Power Generator
Outside Broadcasts
Night Operations
Props Making
Scenery Construction
Firearms/Weapons (includes toys/replicas)
Diving & Underwater Filming
Water Safety
Flying/Airports
Machinery
Cranes/Hoists, Fork Lifts & Access Platforms
Scaffolding & Working at Height
Special Effects
Working Overseas

RISK ASSESSMENT

Nil

Low/Med

High

Hazardous substances, processes

RISK REDUCTION/ACTION RECORD FORM

NOTE:
EVERY RISK IDENTIFIED ON THE HAZARD IDENTIFICATION/RISK ASSESSMENT MUST HAVE A CORRESPONDING ENTRY ON
THIS FORM. THIS FORM MUST BE COMPLETED AND SIGNED IN DUPLICATE. ONE TO BE RETAINED BY THE STUDENT PRODUCER AND ONE
TO BE RETAINED BY THE SUPERVISING LECTURER PRIOR TO PRODUCTION COMENCING.

Things to remember when completing this form:

Ensure all fire and first aid precautions are identified.
Eliminate significant risks from chemicals, electricity, trip hazards, food and catering, lighting, lifting, water and working at height.
Clearly identify any expert help required and specialised equipment needed (e.g. an armourer/licensed shooter is required if any firearms are
to be deployed).
If you are unsure how to use this form, please seek advice from your lecturer.

RISK

PROPOSED ACTION

Fire
First Aid
Old Architecture &
Property
Fatigue/Long hours

Fire blanket + Small extinguisher + Fire Warden on site

First Responder/ First Aid Officer + kit on site
Initial and Final White level checks to be confirmed before
operation. Care to be taken when handling all objects
Constant breaks + Catering provided. Communications
must be upheld. The crew have the option to sleep/rest at
film site as it is a crew members household.
White level inspection and securing with gaffas/tape
Induction/Brief of film site will be commenced to notify crew of
all areas that are hazardous and pose a hazard, prior to
commencement of filming

Trip/Slip Hazard
Confined Space

Lecturer
signature on plan

Producer signature and date

David Nguyen
David Nguyen
David Nguyen

9/4/2016
9/4/2016
9/4/2016

David Nguyen

9/4/2016

David Nguyen
David Nguyen

9/4/2016
9/4/2016