Risk​ ​Assessment​ ​Form​ ​–​ ​Part​ ​A Blank​ ​Template

Reference: [enter​ ​reference​ ​number]] Sign-off​ ​status [planning/approved​ ​etc]

Assessment​ ​summary​ ​details

Home
​ ​Assessment​ ​title
(Simple​ ​name​ ​for​ ​reference
purposes)

Media
​ ​Division: ​ ​Department:
G324​ ​coursework Media​ ​Department
​ ​Series/​ ​Prod/Unit: ​ ​Programme/Area:

Mr​ ​Sheppard Media

​ ​Responsible ​ ​Contact​ ​office:
Manager:
Address/Tel: The​ ​Netherhall​ ​School​ ​and Address/Tel:
Sixth​ ​Form​ ​Centre 01223​ ​242931
Queen​ ​Edith’s​ ​Way CB1​ ​8NN
Cambridge

Date​ ​assessment​ ​created 17/11/17 Confidential​ ​risk NO

assessment?

Create​ ​a​ ​5​ ​minute​ ​short​ ​thriller​ ​film

​ ​Assessment​ ​Outline
(Summary​ ​of​ ​what​ ​is
proposed)

17/11/17 20/11/17
​ ​Assessment​ ​start ​ ​Review​ ​/​ ​End
date date

Cambridge,​ ​England No
​ ​Country​ ​location ​ ​Hostile​ ​/​ ​travel
advisory?
72A​ ​Colville​ ​Road NB:​ ​ ​If​ ​the​ ​country​ ​location​ ​selected​ ​is​ ​‘Hostile’​ ​you​ ​are
​ ​Location​ ​details required​ ​to:​ ​ ​complete​ ​the​ ​BBC​ ​Overseas​ ​High​ ​Risk
CB1​ ​9EH Assessment​ ​Form
 Mr​ ​Sheppard​ ​-​ ​Supervisor
​ ​Crew​ ​/​ ​team
(Roles,​ ​responsibilities, Holly​ ​Littlefair​ ​-​ ​Director/Producer
competencies) John​ ​Paul​ ​Nasayao​ ​-​ ​Cinematographer
Imogen​ ​Done​ ​-​ ​Sound/Lighting
Kristy​ ​Ng​ ​-​ ​Editor/Runner
Tobias​ ​Nicholls,​ ​Tom​ ​Carter,​ ​Elizabeth​ ​Billson​ ​-​ ​Actors

N/A
​ ​Attachments
(Detail​ ​supporting
documents)

Imogen​ ​Done Yes

​ ​Assessor(s) ​ ​Assessor​ ​safety
(Person​ ​drafting​ ​risk competence
assessment)

Mr​ ​Sheppard Date​ ​signed-off​​ ​*

​ ​Authoriser(s)
(Person​ ​responsible​ ​for
sign-off)

​ ​Distribution
Data​ ​Protection​ ​Act:​ ​ ​ ​Personal​ ​information​ ​collected​ ​for​ ​the​ ​purposes​ ​of​ ​risk​ ​assessment​ ​will​ ​be​ ​used​ ​to​ ​identify​ ​those​ ​at​ ​risk,​ ​and
(Who​ ​gets​ ​a​ ​copy​ ​of​ ​the those​ ​involved​ ​in​ ​controlling​ ​risk,​ ​from​ ​this​ ​or​ ​similar​ ​activities​ ​and​ ​to​ ​fulfil​ ​the​ ​BBC's​ ​obligations​ ​under​ ​Health​ ​and​ ​Safety​ ​policy​ ​and
assessment) legislation.​ ​It​ ​will​ ​be​ ​retained​ ​for​ ​up​ ​to​ ​6​ ​years​ ​after​ ​the​ ​expiry​ ​of​ ​the​ ​activity.​ ​It​ ​may​ ​be​ ​shared​ ​with​ ​other​ ​organisations,​ ​including
our​ ​agents​ ​and​ ​contractors,​ ​with​ ​whom​ ​the​ ​risk​ ​or​ ​the​ ​control​ ​of​ ​risk​ ​is​ ​shared.

Activity​ ​and​ ​Hazard​ ​Summary​ ​[This​ ​is​ ​a​ ​summary​ ​of​ ​the​ ​activities​ ​listed​ ​in​ ​part​ ​B​ ​of​ ​the​ ​risk​ ​assessment​.​]
Activity Who​ ​Exposed Hazards{hazard​ ​titles Activity​ ​Risk​ ​Rating
Filming​ ​a​ ​5​ ​minute​ ​thriller​ ​film
Comments​ ​log
Who​ ​by Date​ ​/​ ​time Comments Assessor​ ​response Date/​ ​time
received responded

Risk​ ​Assessment​ ​Form​ ​–​ ​Part​ ​B Blank​ ​Template

6​Reference: [enter​ ​reference​ ​number]] Sign-off​ ​status [planning/approved​ ​etc]

ACTIVITIES:​ ​ ​ ​ ​ ​What​ ​are​ y ​ ou​ ​doing,​ ​where,​ ​for​ ​how​ ​long​ ​and​ ​who​ ​will​ ​be HAZARDS​ ​&​ ​CONTROLS:​ ​ ​ ​ ​ ​How​ ​could​ ​someone​ ​become​ ​hurt​ ​or​ ​made​ ​ill​ ​and
involved?​ ​ ​Complete​ ​the​ ​fields​ ​in​ ​the​ ​form​ ​below). how​ ​are​ ​you​ ​going​ ​to​ ​prevent​ ​this​ ​from​ ​happening?
 Activity​ ​Title: Filming​ ​a​ ​5​ ​minute​ ​thriller​ ​film

Activity​ ​Description: A​ ​young​ ​girl​ ​refuses​ ​to​ ​leave​ ​one​ ​room​ ​in​ ​the​ ​house,​ ​is​ ​interviewed​ ​and​ ​then​ ​when​ ​her​ ​dad​ ​attempts​ ​to​ ​move​ ​her,​ ​she​ ​murders​ ​him

List​ ​those​ ​managing Brendan​ ​Sheppard​ ​-​ ​Supervisor

this​ ​Activity​ ​and​ ​their
competence:
Who​ ​&​ ​how​ ​many
are​ ​at​ ​risk​ ​from​ ​this
Activity?
Holly​ ​Littlefair​ ​-​ ​Director/Producer
John​ ​Paul​ ​Nasayao​ ​-​ ​Cinematographer
Imogen​ ​Done​ ​-​ ​Sound/Lighting
Kristy​ ​Ng​ ​-​ ​Editor/Runner
8

Hazards Control​ ​measures

How​ ​could​ ​someone​ ​become​ ​hurt​ ​or​ ​made​ ​ill
Lighting​ ​-​ ​Could​ ​fall
​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​-​ ​Could​ ​burn​ ​someone
​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​-​ ​Fire​ ​hazard
​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​ ​-​ ​Can​ ​blind​ ​someone
How​ ​are​ ​you​ ​going​ ​to​ ​prevent​ ​this​ ​from​ ​happening?
Stand​ ​lights​ ​correctly​ ​on​ ​tripods,​ ​use​ ​markers​ ​to​ ​prevent​ ​people​ ​bumping​ ​into​ ​it
Use​ ​markers​ ​to​ ​keep​ ​people​ ​at​ ​a​ ​safe​ ​distance,​ ​leave​ ​the​ ​light​ ​before​ ​trying​ ​to​ ​pack​ ​it​ ​away
Follow​ ​the​ ​1m​ ​below​ ​the​ ​ceiling​ ​rule​ ​and​ ​ensure​ ​lights​ ​aren’t​ ​left​ ​on​ ​unnecessarily
Warn​ ​actors​ ​and​ ​crew​ ​before​ ​turning​ ​the​ ​lights​ ​on

Equipment​ ​-​ ​People​ ​can​ ​bump​ ​into​ ​the​ ​equipment​ ​or​ ​trip​ ​over Ensure​ ​all​ ​actors​ ​and​ ​crew​ ​know​ ​where​ ​equipment​ ​and​ ​cables​ ​are/will​ ​be​ ​while​ ​shooting
loose​ ​wires​ ​and​ ​cables

Set​ ​-​ ​Crew​ ​could​ ​be​ ​injured​ ​while​ ​redressing​ ​the​ ​set Make​ ​sure​ ​crew​ ​know​ ​about​ ​manual​ ​handling​ ​hazards

Risk​ ​Level:​ ​ ​After​ ​your​ ​controls​ ​have​ ​been​ ​applied​ ​what​ ​is​ ​your​ ​assessment​ ​of​ ​the​ ​risk​ ​level​ ​of Low
this​ ​activity?