LOCATION THIS FORM RELATES TO: House, car.

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?

Severity

Likelihood

Risk Factor
n/a

Alcohol/drugs

n/a

n/a

Animals/insects

VU

Audiences

n/a

n/a

n/a

Camera cable/grip equipment

n/a

n/a

n/a

Confined spaces

VU

Derelict buildings/dangerous structures

n/a

n/a

n/a

Electricity/gas (other than normal supplies)

VU

Fatigue/long hours

n/a

n/a

n/a

Fire/flammable materials

n/a

n/a

n/a

10

Hazardous substances

n/a

n/a

n/a

11

Heat/Cold/extreme weather

n/a

n/a

n/a

12

Laser/strobe effects

VL

13

Machinery/industrial/ crane/hoist

n/a

n/a

n/a

14

Materials - glass, non-fire retardant set materials

VU

15

Night operation

VU

16

Noise high sound levels

n/a

n/a

n/a

17

Non standard manual handling

n/a

n/a

n/a

18

Public/crowds

n/a

n/a

n/a

19

Radiation

n/a

n/a

n/a

20

Scaffold/Rostra

n/a

n/a

n/a

21

Smoking on set

n/a

n/a

n/a

22

Special effects/explosives

n/a

n/a

n/a

23

Special needs (elderly, disabled, inexperienced)

VU

24

Specialised rescue/first aid

n/a

n/a

n/a

25

Stunts, dangerous activities

n/a

n/a

n/a

26

Tall scenery/suspended ceilings

n/a

n/a

n/a

27

Vehicles/speed

28

Water/proximity to water

n/a

n/a

n/a

29

Weapons

30

Working at heights

n/a

n/a

n/a

31

Working overseas

n/a

n/a

n/a

32

Other risks

n/a

n/a

n/a

Possible
4
3
3
2
2

Likely
5
3
3
3
2

Calculate the Risk Factor:

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

Then list each risk identified

Unlikely
4
3
2
2
1

Take immediate action

High priority
Programme for action
Action may be required
Probably acceptable

Very Likely
5
5
3
3
3

LOCATION RISK ASSESSMENT FORM

SHOOT DATE/S: 11th 12th November

PRODUCTION TITLE: Fever the Ghost Music Video

Hazard no:
Description

2
One domestic house cat.

Person(s) exposed (detail if

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

I am allergic. (C)

Risk Factor (1-5)

Do not touch the cat.

Person/company responsible Dan.

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

Hazard no:
Description

5
Risk Factor (1-5)
Small rooms, such as bathroom. Interior of car.

Person(s) exposed (detail if

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

Filming in locations. (C)

Risk removed? (y/n)

Do not panic, careful non-sporadic movements.

Person/company responsible Dan.

for action
To be completed at agreed later date Exposed person(s)
Y
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description

7
Inside house and car.

Person(s) exposed (detail if

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

Filming in locations. (C)

Risk removed? (y/n)

Risk Factor (1-5)

None, filming is not in immediate area of risks.

Person/company responsible
for action
To be completed at agreed later date Exposed person(s)
Y
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description

12
Strobe bicycle lights.

Person(s) exposed (detail if

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

Used in filming portions. (C)

Risk removed? (y/n)

Risk Factor (1-5)

Take breaks between filming, as it can interfere with eyes.

Person/company responsible
for action
To be completed at agreed later date -

Exposed person(s)
informed? (y/n)

Agreed action taken? (y/n)

Hazard no:
Description

14
Risk Factor (1-5)
Windows, clothes and furniture.

Person(s) exposed (detail if

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

Filming in locations. (C)

Risk removed? (y/n)

None, as fire will not be present during filming.

Person/company responsible
for action
To be completed at agreed later date Exposed person(s)
N
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description

15
Time of filming.

Person(s) exposed (detail if

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

Filming in locations. (C)

Risk Factor (1-5)

Risk removed? (y/n)

None, filming provides no risk in locations.

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

Hazard no:
Description

23
Risk Factor (1-5)
Inexperienced actors and director.

Person(s) exposed (detail if

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

(C)

Risk removed? (y/n)

None.

Person/company responsible
for action
To be completed at agreed later date Exposed person(s)
N
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description

27
Car.

Person(s) exposed (detail if

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

Interior and exterior used in filming. (C)

Risk Factor (1-5)

Drive within legal limits and with caution.

Risk removed? (y/n)

Person/company responsible Dan.

for action
To be completed at agreed later date Exposed person(s)
Y
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description

29
Two baseball bats.

Person(s) exposed (detail if

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

Used as props in filming. (C)

Risk Factor (1-5)

Risk removed? (y/n)

Swings object while aware of surroundings and without full force.

Person/company responsible Dan and Ella.

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: Frankie

Position: Director

Signature

Date:

09/12/2016