You are on page 1of 3

Risk Assessment Form Part A

Reference:
[enter reference number]]

Blank Template

Sign-off status

[planning/approved etc]

Assessment summary details


Assessment title * (Simple name for reference purposes) Di ision:* Series! Prod!"nit: Responsi#le $anager: Address/Tel: Department:* Programme!Area: %ontact office: Address/Tel:

Date assessment created

%onfidential risk assessment&

'(S!)* +delete as applica#le,

Assessment *utline (Summary of what is proposed) Assessment start date %ountry location Re ie- ! (nd date

.ostile ! tra el ad isory& )B: 0f t1e country location selected is 2.ostile3 you are re4uired to: complete t1e BB% * erseas .ig1 Risk Assessment Form

/ocation details

%re- ! team (Roles, responsibilities, competencies) Attac1ments (Detail supporting documents) Assessor+s,

( erson drafting ris! assessment) Aut1oriser+s, * ( erson responsible for sign"off) Distri#ution (#ho gets a copy of the assessment)

Assessor safety competence

Date signed-off *

Data rotection Act: ersonal information collected for the purposes of ris! assessment will be used to identify those at ris!, and those in$ol$ed in controlling ris!, from this or similar acti$ities and to fulfil the %%&'s obligations under (ealth and Safety policy and legislation) *t will be retained for up to + years after the e,piry of the acti$ity) *t may be shared with other organisations, including our agents and contractors, with whom the ris! or the control of ris! is shared)

Acti ity and .a5ard Summary


Acti ity

6T1is is a summary of t1e acti ities listed in part B of t1e risk assessment )7 81o (9posed .a5ards:1a5ard titles Acti ity Risk Rating

%omments log
81o #y Date ! time recei ed %omments Assessor response Date! time responded

6* mandatory fields7

Risk Assessment Form Part B


+

Reference:

[enter reference number]]

Sign-off status

planning

A%T0;0T0(S: #hat are you doing, where, for how long and who will be in$ol$ed- &omplete the fields in the form below)) Acti ity Title: Acti ity Description: Shift

.A<ARDS = %*)TR*/S: (ow could someone become hurt or made ill and how are you going to pre$ent this from happening-

*ne actor c1asing do-n anot1er t1roug1 an alley and t1en fig1ting 1im in t1e small yard>

/ist t1ose managing t1is Acti ity and t1eir competence: 81o = 1o- many are at risk from t1is Acti ity&

.ichael *bbs / Director

T-o actors

.a5ards (ow could someone become hurt or made ill Accidental in0ury due to the fighting in the scene)

%ontrol measures (ow are you going to pre$ent this from happeningActors will be shown beforehand where and how to stand and not to put any real force behind blows as the camera will not directly show them getting hit) Scene will be rehearsed multiple times)

Truc! may bac! into alley and hit actors

The filming in the alley will ta!e place when no truc!s are scheduled to arri$e) #hen in the yard the camera and actors will be away from the)

Risk /e el*: After your controls ha$e been applied what is your assessment of the ris! le$el of this acti$ity-

/o-

6* mandatory fields7

Risk Assessment Form Part B


+

Blank Template

Reference:

[enter reference number]]

Sign-off status

[planning/approved etc]

A%T0;0T0(S: #hat are you doing, where, for how long and who will be in$ol$ed- &omplete the fields in the form below)) Acti ity Title:* Acti ity Description: 1acti$ity 2 title3

.A<ARDS = %*)TR*/S: (ow could someone become hurt or made ill and how are you going to pre$ent this from happening-

/ist t1ose managing t1is Acti ity and t1eir competence: 81o = 1o- many are at risk from t1is Acti ity& .a5ards (ow could someone become hurt or made ill 1(a4ard 5 title and description3 %ontrol measures (ow are you going to pre$ent this from happening1Details of control measures3

1(a4ard 2 title and description3 [add additional rows as required]

1Details of control measures3

Risk /e el*: After your controls ha$e been applied what is your assessment of the ris! le$el of this acti$ity-

.ig1!$edium!/o-

+delete as applica#le,

Add additional activities as required by copying this section and pasting below

6* mandatory fields7