SHOOT DATE/S:

PRODUCTION OFFICE PHONE/MOBILE:

LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location)

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

3
4

Audiences
Camera cable/grip equipment

5
6

Confined spaces
Derelict buildings/dangerous structures

7
8
9

Electricity/gas (other than normal supplies)

Fatigue/long hours
Fire/flammable materials

10
11

Hazardous substances
Heat/Cold/extreme weather

12
13

Laser/strobe effects
Machinery/industrial/ crane/hoist

14
15

Severity

Likelihood

Risk Factor

yes

VL

Materials - glass, non-fire retardant set materials

Night operation

yes

VL

16
17
18

Noise high sound levels

Non standard manual handling
Public/crowds

yes

19
20

Radiation
Scaffold/Rostra

21
22

Smoking on set
Special effects/explosives

23
24
25

Special needs (elderly, disabled, inexperienced)

Specialised rescue/first aid
Stunts, dangerous activities

26
27

Tall scenery/suspended ceilings

Vehicles/speed

28
29

Water/proximity to water
Weapons

30
31

Working at heights
Working overseas

32

Other risks

Unlikely

Possible

Likely

Very Likely

4
3
2
2
1

4
3
3
2
2

5
3
3
3
2

5
5
3
3
3

Calculate the Risk Factor:

Very Unlikely
Very severe
Severe
Moderate
Slight
Negligible

3
2
2
1
1

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

LOCATION RISK ASSESSMENT FORM

PRODUCTION TITLE:

Hazard no: 1
Description
Person(s) exposed (detail if
cast/crew (C), outside
company (O) or public (P) )
Action to take

Alcohol and drugs

Risk Factor (1-5)
3
I will be filming in a night club so there will be alcohol present amongst the crowd Ill
be filming.

I will not drink alcohol so I am fully aware of my safety and the safety of the
equipment.

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

Hazard no: 2
Description

Night operation
Risk Factor (1-5)
I will be filming in a night club

Person(s) exposed (detail if

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

Public and myself

Person/company responsible
for action
To be completed at agreed later date Exposed person(s)
Agreed action taken? (y/n)
informed? (y/n)
Hazard no:
Description
Person(s) exposed (detail if
cast/crew (C), outside
company (O) or public (P) )
Action to take

Risk removed? (y/n)

Risk removed? (y/n)

3
Risk Factor (1-5)
3
There will be public while filming and there is a big chance they will be intoxicated.

Try and get the footage quickly to lower risk ofdamage to the equipment. Also
myself and the public.

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

Position:

Signature

Date:

Countersigned by:

PRODUCER

Signature

Date: