LOCATION RISK ASSESSMENT FORM
PRODUCTION TITLE: Promotional Video PRODUCTION OFFICE PHONE/MOBILE: Home (Tutor Will Have) LOCATION THIS FORM RELATES TO: Great Ellingham Field
SHOOT DATE/S: 5th of April 2013
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 below. Hazard 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Alcohol/drugs Animals/insects Audiences Camera cable/grip equipment Confined spaces Derelict buildings/dangerous structures Electricity/gas (other than normal supplies) Fatigue/long hours Fire/flammable materials Hazardous substances Heat/Cold/extreme weather Laser/strobe effects Machinery/industrial/ crane/hoist Materials - glass, non-fire retardant set materials Night operation Noise  high sound levels Non standard manual handling Public/crowds Radiation Scaffold/Rostra Smoking on set Special effects/explosives Special needs (elderly, disabled, inexperienced) Specialised rescue/first aid Stunts, dangerous activities Tall scenery/suspended ceilings Vehicles/speed Water/proximity to water Weapons Working at heights Working overseas Other risks y l p 2 Present? Severity Likelihood Risk Factor
Calculate the Risk Factor:
Very severe Severe Moderate Slight Negligible Very Unlikely 3 2 2 1 1 Unlikely 4 3 2 2 1 Possible 4 3 3 2 2 Likely 5 3 3 3 2 Very Likely 5 5 3 3 3
Decide the action to take: 5 Very severe 4 Severe 3 Moderate Risk 2 Low Risk 1 Negligible
Take immediate action High priority Programme for action Action may be required Probably acceptable
Then list each risk identified
Hazard no: Description Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) ) Action to take
2 Risk Factor (1-5) Insects and Dog/Horse riders on field Emma Clarke Action may be required
Person/company responsible Emma Clarke for action To be completed at agreed later date Exposed person(s) y Agreed action taken? (y/n) informed? (y/n) Completed by: Emma Clarke Date: 5th of April 2013
Risk removed? (y/n)
Position: Direction/Producer