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Risk Assessment Form – Part A
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Production Name:
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Revenge
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Organisation
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Production Address:
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Ellesmere
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Producer / Editor
Tel:
Mobile:
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Melissa, Gigi
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-
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Start date
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07/02/2018
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End date
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05/03/2018
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Distribution
Who gets a copy of the assessment
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Melissa Fu, Gigi Zhang
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Outline of risk assessment
Summary of what is proposed in terms of sequences and set ups.
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Multiple scenes of walking through streets, scenes of ‘homeless child’ sitting down on the street, scenes in the bar, scenes in the chapel
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Team members / experts / contractors / contributors etc.
List those involved
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Melissa Fu, Gigi Zhang
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Locations
Outline locations involved – indicate any which are hostile environments
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Ellesmere
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Assessor Name
Signature
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Date completed
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Authoriser Name
(if not Assessor) Signature
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Date authorised
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Hazard list – select your hazards from the list below and use these to complete Part B
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Situational hazards
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Tick
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Physical / chemical hazards
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Tick
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Health hazards
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Tick
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Assault by person
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X
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Contact with cold liquid / vapour
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Disease causative agent
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Attack by animal
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Contact with cold surface
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X
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Infection
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Breathing compressed gas
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Contact with hot liquid / vapour
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Allergic reaction
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Cold environment
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X
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Contact with hot surface
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Lack of food / water
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Crush by load
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Electric shock
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Lack of oxygen
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Drowning
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Explosive blast
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Physical fatigue
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X
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Entanglement in moving machinery
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Explosive release of stored pressure
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Repetitive action
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High atmospheric pressure
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Fire
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Static body posture
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Hot environment
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Hazardous substance
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Stress / anxiety
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X
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Manual handling
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Ionizing radiation
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Venom poisoning
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Object falling, moving or flying
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Laser light
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Obstruction / exposed feature
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X
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Lightning strike
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Environmental hazards
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Sharp object / material
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Noise
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Litter
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Shot by firearm
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Non-ionizing radiation
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Nuisance noise / vibration
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X
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Slippery surface
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X
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Stroboscopic light
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Physical damage
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Trap in moving machinery
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Vibration
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Waste substance released into air
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Trip hazard
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Waste substance released into soil / water
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Vehicle impact / collision
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Managerial / organisational hazards
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Falls from height
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Management factors (lack of communication, co-operation, co-ordination and competence)
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Risk matrix – use this to determine risk for each hazard i.e. ‘how bad and how likely’
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Likelihood of Harm
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Severity of Harm
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Remote
e.g. <1 in 1000 chance
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Very unlikely
e.g. 1 in 200 chance
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Unlikely
e.g. 1 in 50 chance
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Possible
e.g. 1 in 10 chance
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Likely
e.g. >1 in 3 chance
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Negligible e.g. small bruise
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Trivial
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Trivial
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Trivial
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Low
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Low
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Slight e.g. small cut, deep bruise
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Trivial
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Trivial
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Low
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Low
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Medium
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Moderate e.g. deep cut, torn muscle
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Trivial
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Low
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Medium
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Medium
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High
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Severe e.g. fracture, loss of consciousness
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Low
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Medium
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High
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High
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Extremely high
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Very Severe e.g. death, permanent disability
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Low
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Medium
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High
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Extremely high
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Extremely high
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Risk Assessment Form – Part B
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Continue on separate sheet if necessary
1 – complete separate table for each activity 2 - from hazard list in Part A 3 - from risk matrix in Part A
Activity1 – Each individual activity you are proposing:
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Location – where this activity will take place:
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Dates / times:
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Hazards2
List what could cause harm from this activity
e.g. falls from height, trip hazard, fire, etc.
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Who exposed
List who might be harmed from this activity
e.g. staff, contractors, contributors, public, etc.
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Risk3
For each hazard, decide level of risk as if you were to do the activity without your controls
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Control measures
For each hazard, list the measures you will be taking to minimise the risk identified
e.g. appointing competent persons, training received, planning and rehearsals, use of personal protective equipment, provision of first aid, etc.
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Risk3
For each hazard, decide level of risk once all your controls are in place
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Assault by person
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ALL
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Remote - Very Severe
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Avoid arguments with any members of the public. Prepare the first-aid kit
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Remote - slight
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Cold environment
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ALL
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Possible - severe
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Warm clothing will be advised to be worn when the actors are not acting. If an actor is extreme cold, we will consider to film the scene in a warmer day which this actor has involved in
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N/a
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Slippery surface
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ALL
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Possible - negligible
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Skid shoes or stout footwear is advised where possible. When walking outside, walk slowly and care should be made by all actors
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Remote-negligible
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Contact with cold surface
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Homeless actor
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Remote - negligible
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Actor must ensure that he is warm enough and he avoids touching any cold surfaces
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Remote - negligible
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Nuisance noise/vibration
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ALL
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Very unlikely - moderate
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Keep the filming place at least 5 meters away from the noise
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N/a
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Physical fatigue
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Actors and actresses
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Remote - very severe
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Medicine should be brought and a phone should be brought to ensure support can be requested if needed
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N/a
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Stress/anxiety
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Actors and actresses
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Remote - negligible
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Stop filming and take a rest if the actor is stressful, talk to him and make him calm down
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Remote - very severe
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