RISK ASSESSMENT FORM | ||||
Shoot date
| Production Title | Page of | ||
17.10.15
|
Jealous Type
| |||
Producer | ||||
Sumaya
|
Location: Edmonton
| |||
Address: Streamside Cl, London, England N9
|
RATINGS:
- each risks severity on scale from Negligable1 (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)
- risk factor from the table overleaf.
Hazard |
Present?
|
Severity
|
Likelihood
|
Risk Factor
| |
1
|
Alcohol/drugs
|
n
|
L
|
VU
|
3
|
2
|
Animals/insects
|
n
|
L
|
VU
|
3
|
3
|
Audiences
|
n
|
L
|
VU
|
3
|
4
|
Camera cable/grip equipment
|
N
|
L
|
VU
|
3
|
5
|
Confined spaces
|
n
|
L
|
VU
|
3
|
6
|
Derelict buildings/dangerous structures
|
n
|
L
|
VU
|
3
|
7
|
Electricity/gas (other than normal supplies)
|
n
|
L
|
VU
|
3
|
8
|
Fatigue/long hours
|
y
|
M
|
VU
|
3
|
9
|
Fire/flammable materials
|
n
|
L
|
VU
|
3
|
10
|
Hazardous substances
|
n
|
L
|
VU
|
3
|
11
|
Heat/Cold/extreme weather
|
n
|
L
|
VU
|
3
|
12
|
Laser/strobe effects
|
n
|
L
|
VU
|
3
|
13
|
Machinery/industrial/ crane/hoist
|
N
|
L
|
VU
|
3
|
14
|
Materials - glass, non-fire retardant set materials
|
n
|
L
|
VU
|
3
|
15
|
Night operation
|
n
|
L
|
VU
|
3
|
16
|
Noise – high sound levels
|
n
|
L
|
VU
|
3
|
17
|
Non standard manual handling
|
n
|
L
|
VU
|
3
|
18
|
Public/crowds
|
n
|
L
|
VU
|
3
|
19
|
Radiation
|
n
|
L
|
VU
|
3
|
20
|
Scaffold/Rostra
|
n
|
L
|
VU
|
3
|
21
|
Smoking on set
|
n
|
L
|
VU
|
3
|
22
|
Special effects/explosives
|
n
|
L
|
VU
|
3
|
23
|
Special needs (elderly, disabled, inexperienced)
|
n
|
L
|
VU
|
3
|
24
|
Specialised rescue/first aid
|
n
|
L
|
VU
|
3
|
25
|
Stunts, dangerous activities
|
n
|
L
|
VU
|
3
|
26
|
Tall scenery/suspended ceilings
|
n
|
L
|
VU
|
3
|
27
|
Vehicles/speed
|
n
|
L
|
VU
|
3
|
28
|
Water/proximity to water
|
n
|
L
|
VU
|
3
|
29
|
Weapons
|
n
|
L
|
VU
|
3
|
30
|
Working at heights
|
n
|
L
|
VU
|
3
|
31
|
Working overseas
|
n
|
L
|
VU
|
3
|
32
|
Other risks
|
n
|
L
|
VU
|
3
|
Calculate the Risk Factor:
Very Unlikely |
Unlikely
|
Possible
|
Likely
|
Very Likely
| |
Very severe
|
3
|
4
|
4
|
5
|
5
|
Severe
|
2
|
3
|
3
|
3
|
5
|
Moderate
|
2
|
2
|
3
|
3
|
3
|
Low
|
1
|
2
|
2
|
3
|
3
|
Negligible
|
1
|
1
|
2
|
2
|
3
|
Decide the action to take:
5
|
Very severe
|
Take immediate action
|
4
|
Severe
|
High priority
|
3
|
Moderate Risk
|
Programme for action
|
2
|
Low Risk
|
Action may be required
|
1
|
Negligible
|
Probably acceptable
|
Then list each risk identified
Hazard no: 8
|
Risk Factor (1-5):
| ||||||
Description
|
Fatigue/long hours – there is going to be unforeseen changes.
| ||||||
Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )
|
Cast/crew
| ||||||
Action to take
|
Ensure that we stick to the storyboard and timings.
| ||||||
Person/company responsible for action
|
producer
| ||||||
To be completed at agreed later date
| |||||||
Exposed person(s) informed? (y/n)
|
y
|
Agreed action taken? (y/n)
|
y
|
Risk removed? (y/n)
|
Y
|
Hazard no:
|
Risk Factor (1-5):
| ||||||
Description
| |||||||
Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )
| |||||||
Action to take
| |||||||
Person/company responsible for action
| |||||||
To be completed at agreed later date
| |||||||
Exposed person(s) informed? (y/n)
|
y
|
Agreed action taken? (y/n)
|
y
|
Risk removed? (y/n)
|
Y
| ||
Hazard no:
|
Risk Factor (1-5):
| ||||||
Description
| |||||||
Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )
| |||||||
Action to take
| |||||||
Person/company responsible for action
|
producer
| ||||||
To be completed at agreed later date
| |||||||
Exposed person(s) informed? (y/n)
|
Y
|
Agreed action taken? (y/n)
|
y
|
Risk removed? (y/n)
|
y
|
Hazard no:
|
Risk Factor (1-5):
| ||||||
Description
| |||||||
Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )
| |||||||
Action to take
| |||||||
Person/company responsible for action
| |||||||
To be completed at agreed later date
| |||||||
Exposed person(s) informed? (y/n)
|
y
|
Agreed action taken? (y/n)
|
y
|
Risk removed? (y/n)
|
Y
|
Hazard no:
|
Risk Factor (1-5):
| ||||||
Description
| |||||||
Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )
| |||||||
Action to take
| |||||||
Person/company responsible for action
| |||||||
To be completed at agreed later date
| |||||||
Exposed person(s) informed? (y/n)
|
y
|
Agreed action taken? (y/n)
|
y
|
Risk removed? (y/n)
|
Y
|
Hazard no:
|
Risk Factor (1-5):
| ||||||
Description
| |||||||
Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )
| |||||||
Action to take
| |||||||
Person/company responsible for action
| |||||||
To be completed at agreed later date
| |||||||
Exposed person(s) informed? (y/n)
|
Y
|
Agreed action taken? (y/n)
|
y
|
Risk removed? (y/n)
|
y
|
Hazard no:
|
Risk Factor (1-5):
| ||||||
Description
| |||||||
Person(s) exposed (detail if cast/crew (C), outside company (O) or public (P) )
| |||||||
Action to take
| |||||||
Person/company responsible for action
| |||||||
To be completed at agreed later date
| |||||||
Exposed person(s) informed? (y/n)
|
y
|
Agreed action taken? (y/n)
|
y
|
Risk removed? (y/n)
|
Y
|
Completed by: Erinm Position: Producer
Signature SARAH Date: 06/10/2015
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