SHOOT DATE/S: November 2015

PRODUCTION OFFICE PHONE/MOBILE: 07591173062

LOCATION THIS FORM RELATES TO: (A separate form should be completed for each location)
Debut Restaurant, City College Norwich Campus, Ipswich Road, NR2 2LJ
Complete the following table rating

each risks severity on scale from Negligible (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

Present?

Severity

Likelihood

Risk Factor

1
2

Alcohol/drugs
Animals/insects

NO
NO

/
/

/
/

/
/

3
4

Audiences
Camera cable/grip equipment

NO
YES

/
N

/
VU

/
1

5
6

Confined spaces
Derelict buildings/dangerous structures

YES
NO

L
/

VU
/

1
/

7
8
9

Electricity/gas (other than normal supplies)

Fatigue/long hours
Fire/flammable materials

YES
NO
YES

M
/
M

P
/
P

3
/
3

10
11

Hazardous substances
Heat/Cold/extreme weather

NO
NO

/
/

/
/

/
/

12
13

Laser/strobe effects
Machinery/industrial/ crane/hoist

NO
YES

/
L

/
U

/
1

14
15

Materials - glass, non-fire retardant set materials

Night operation

YES
NO

N
/

VU
/

1
/

16
17
18

Noise high sound levels

Non standard manual handling
Public/crowds

NO
NO
NO

/
/
/

/
/
/

/
/
/

19
20

Radiation
Scaffold/Rostra

NO
NO

/
/

/
/

/
/

21
22

Smoking on set
Special effects/explosives

NO
NO

/
/

/
/

/
/

23
24
25

Special needs (elderly, disabled, inexperienced)

Specialised rescue/first aid
Stunts, dangerous activities

NO
NO
NO

/
/
/

/
/
/

/
/
/

26
27

Tall scenery/suspended ceilings

Vehicles/speed

NO
NO

/
/

/
/

/
/

28
29

Water/proximity to water
Weapons

YES
YES

N
M

VU
P

1
3

30
31

Working at heights
Working overseas

NO
NO

/
/

/
/

/
/

32

Other risks

NO

Unlikely

Possible

Likely

Very Likely

4
3
2
2
1

4
3
3
2
2

5
3
3
3
2

5
5
3
3
3

Calculate the Risk Factor:

Very Unlikely
Very severe
Severe
Moderate
Slight
Negligible

3
2
2
1
1

Decide the action to take:

5
Very severe
4
Severe
3
Moderate Risk
2
Low Risk
1
Negligible

List each risk identified

Take immediate action

High priority
Programme for action
Action may be required
Probably acceptable

LOCATION RISK ASSESSMENT FORM

PRODUCTION TITLE: Uma Thurman Lip-sync

Hazard no:
Description

7
Risk Factor (1-5)
3
Electricity/gas: kitchen appliances such as ovens and gas rings/hobs with
ignition dials

Person(s) exposed (detail if

cast/crew (C), outside
company (O) or public (P) )
Action to take

Cast/crew
Brief on safety: do not touch dials, lean/place hands on gas rings, turn on
appliances

Person/company responsible Producer

for action
To be completed at agreed later date Exposed person(s)
Y
Agreed action taken? (y/n)
informed? (y/n)

Hazard no:
Description

9
Risk Factor (1-5)
Fire: gas hobs and ovens, only when lit

Person(s) exposed (detail if

cast/crew (C), outside
company (O) or public (P) )
Action to take

Cast/crew

Hazard no:
Description

29
Risk Factor (1-5)
Weapons: sharp kitchen knives and tools

Person(s) exposed (detail if

cast/crew (C), outside
company (O) or public (P) )
Action to take

Cast/crew

Completed by: Poppy Matless

Signature

Risk removed? (y/n)

Removal of items from the set

Person/company responsible Producer

for action
To be completed at agreed later date Exposed person(s)
Y
Agreed action taken? (y/n)
informed? (y/n)

Risk removed? (y/n)

Position: Director

PMatless

Countersigned by:

Brief on safety: do not switch appliances on

Person/company responsible Producer

for action
To be completed at agreed later date Exposed person(s)
Y
Agreed action taken? (y/n)
informed? (y/n)

Signature

Risk removed? (y/n)

Date: 16/11/15

PRODUCER
Date: