Blank Risk Assessment form by Cb15BRN

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									BATHFILMOFFICE
                                              RISK ASSESSMENT FORM




PRODUCTION:                                   SHOOTING DATE:

Location address:                             Contact name:

                                              Telephone number:


Production/Director Unit Manager or Safety Co-ordinator:
Telephone number:


This form must be completed and returned to the Bath Film Office. A
separate sheet should be completed for each location. Tick each hazard as
appropriate. All hazards must be identified to support personnel working on
location. Complete this document on reverse; carry out Risk Assessment and
state necessary action.

                           HAZARD CHECK LIST

Access/Egress                     □ Working at heights                   □
Aircraft/Microlights/             □ Lasers                               □
Balloons/Parachutes
Animals                           □ Lifting appliances/Machinery         □
Asbestos                          □ Manual lifting/Handling              □
Audience/Public                   □ Mines/Excavation/Caves/              □
                                    Tunnels/Quarries
Hazardous                         □ Noise                                □
substances/Chemicals/
Drugs/Micro-organisms/
Compressed gas
Confined spaces                   □ Night shooting                       □
Derelict buildings/               □ Radiation                            □
Dangerous structures
Diving operations                 □   Public highway                     □
Electricity or Gas                □   Scaffolds/Rostra                   □
Explosives/Pyrotechnics           □   Speed                              □
Fires/Flammable materials         □   Stunts                             □
Firearms/Ammunitions/Weapons      □   Vehicles                           □
Glass in scenery                  □   Water/Proximity to water           □
Heat/Cold                         □   Additional hazards                 □



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BATHFILMOFFICE


Details of Activity: (please include sketch where this would be helpful)




          Hazard                Date      Severity       Person(s) at Risk          Likelihood         Precautions e.g.         Source of safety advice
                                          (H,M,L)      (Whom, How many?)             (H,M,L)          Safety equipment          And competent persons




When completing the above table consider nature of hazard (see overleaf), the possible severity of outcome, e.g. High = severe or multiple injuries, Medium
= lost time injury, Low = minor, first aid injury. How many people are at risk and who are they? How likely that incident will occur? Are the precautions
proportionate to the overall risk?

I have read the above information and am satisfied that an adequate risk assessment has been carried out in respect of this
production/location:

Signature of Producer/Director or Unit Manager: ……………………………………………………………… Date: ………………………………..




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