RISK ASSESSMENT FORM

Production name & number - Production office telephone

Shoot dates
List of location(s) form relates to
Production manager name and mobile number; 1st AD name and mobile; (exec) Producer name
and mobile.
Complete the following table rating
each risks severity on scale from Negligable (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
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27

Alcohol/drugs
Animals/insects
Audiences
Camera cable/grip equipment
Confined spaces
Derelict buildings/dangerous structures
Electricity/gas (other than normal supplies)
Fatigue/long hours
Fire/flammable materials
Hazardous substances
Heat/Cold/extreme weather
Laser/strobe effects
Machinery/industrial/ crane/hoist
Materials - glass, non-fire retardant set materials
Night operation
Noise high sound levels
Non standard manual handling
Public/crowds
Radiation
Scaffold/Rostra
Smoking on set
Special effects/explosives
Special needs (elderly, disabled, inexperienced)
Specialised rescue/first aid
Stunts, dangerous activities
Tall scenery/suspended ceilings
Vehicles/speed

Pr
es
en
t?

N
Y
Y
Y
Y
N
N
Y
N
N
Y
N
N
N
N
Y
N
Y
N
N
Y
N
Y
Y
N
Y
Y

S
e
v
e
ri
t
y

N
L
L
L
L
L
N
M
L
N
M
N
N
L
N
M
N
S
L
L
L
N
L
S
L
M
V

L
i
k
e
li
h
o
o
d
VU
U
U
P
P
VU
VU
P
VU
VU
P
VU
VU
U
VU
P
VU
L
VU
P
P
VU
P
L
U
L
VL

Risk
Fact
or

1
2
2
2
2
2
1
3
3
1
3
1
1
2
1
3
1
3
3
2
2
1
2
3
2
3
5

28
Water/proximity to water
29
Weapons
30
Working at heights
31
Working overseas
32
Other risks
Calculate the Risk Factor:

Very severe
Severe
Moderate
Slight
Negligible

Very Unlikely
3
2
2
1
1

N
N
N
N
Y

Unlikely
4
3
2
2
1

Possible
4
3
3
2
2

N
N
L
N
L

Likely
5
3
3
3
2

VU
VU
U
VU
U

Very Likely
5
5
3
3
3

Decide the action to take:

5
4
3
2
1

Very severe
Severe
Moderate Risk
Low Risk
Negligible

Take immediate action

High priority
Programme for action
Action may be required
Probably acceptable

Then list each risk identified

Hazard no:
2
3
4
5
8
11
16
18
21
23
24
26
27
32
Person(s) exposed
(detail if cast/crew (C),
outside company (O) or
public (P) )
Action to take

Risk Factor (1-5)

2
2
2
2
3
3
3
3
2
2
3
3
5
3
Morgan, Matt, Chloe, Jordan, Paige

Be sensible and aware

Person/company
Saltwork Productions Team Rainbow
responsible for action
To be completed at agreed later date Exposed person(s)
Agreed action taken? (y/n)
informed? (y/n)

1
1
2
1
3

Risk removed?
(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:

Position:

Signature

Date:

Countersigned by:

PRODUCER

Signature

Date: