SHOOT DATE/S: 30/10/14

PRODUCTION OFFICE PHONE/MOBILE: 07807 808466

LOCATION THIS FORM RELATES TO: Dunwich Heath

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
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

Materials - glass, non-fire retardant set materials

Night operation

16
17
18

Noise high sound levels

Non standard manual handling
Public/crowds

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

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

Present?

Severity

Likelihood

Risk Factor

VU

VU

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

Take immediate action

High priority
Programme for action
Action may be required
Probably acceptable

LOCATION RISK ASSESSMENT FORM

PRODUCTION TITLE: For the Man I Loved

Hazard no:
Description

1
Risk Factor (1-5)
1
Location is home to various animals and insects very low risk of minor insect
bites.

Person(s) exposed (detail if

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

C
Probably acceptable.

Person/company responsible N/A

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)

Hazard no:
Description

18
Risk Factor (1-5)
1
Location is owned by National Trust there may be visitors present during filming.

Person(s) exposed (detail if

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

C, P
Probably acceptable

Person/company responsible Director

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

Risk removed? (y/n)

Hazard no:
Description

28
Risk Factor (1-5)
2
Filming next to the sea possibility of tide coming in whilst still filming.

Person(s) exposed (detail if

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

C
Action may be required.

Person/company responsible Director

for action
To be completed at agreed later date Exposed person(s)
Y
Agreed action taken? (y/n)
Y
Risk removed? (y/n)
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: Victoria Casey
Signature:

V. Casey

Position: Director
Date: 05/10/14