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Risk Assessme NT Form - Part A: Reference: Sign-Off Status Assessment Summary Details
Risk Assessme NT Form - Part A: Reference: Sign-Off Status Assessment Summary Details
Risk Assessme NT Form - Part A: Reference: Sign-Off Status Assessment Summary Details
Assessme
nt Form
Part A
Reference:
[enter reference
number]]
Alex Madej
Kira Bannard
Sign-off status
[planning/approved
etc]
Assessment
summary details
Assessment title *
(Simple name for
reference purposes)
Poison
Division:*
--------
Department:*
Media
Series/ Prod/Unit:
-------
Programme/Area:
---------
Responsible Manager:
Brendan Sheppard
Contact office:
Media
The Netherhall
School and Sixth
Form Centre
Queen Ediths Way
Cambridge
Address/Tel:
Date assessment
created
11/11/15
Confidential risk
assessment?
Assessment Outline
(Summary of what is
proposed)
To produce a Film
Noir 2-4 opening
sequence using the
Media departments
studio with cameras,
sound and lighting
Assessment start
date
17/11/15
Address/Tel:
Country location
England, Cambridge
Hostile / travel
advisory?
Location details
The Netherhall
School and Sixth
Form Centre
Queen Ediths Way
Cambridge
Crew / team
(Roles,
responsibilities,
competencies)
Attachments
--------
The Netherhall
School and Sixth
Form Centre
YES/NO (delete as
applicable)
17/11/15
---
(Detail supporting
documents)
Assessor(s)
Alex Madej
Kira Bannard
Authoriser(s) *
(Person responsible for
sign-off)
Distribution
(Who gets a copy of the
assessment)
Assessor safety
competence
----------
Date signed-off *
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
Blank Template
Risk
Assessme
nt Form
Part B
Reference:
ACTIVITIES:
What are you doing,
where, for how long
and who will be
involved? Complete
the fields in the form
below).
[enter reference
number]]
Sign-off status
[planning/approved
etc]
HAZARDS &
CONTROLS:
How
could someone
become hurt or
made ill and how are
you going to prevent
this from happening?
Activity Title:*
Activity Description:
Kira Bannard:
David (Actor)
Alex Madej:
Virginia (Actor)
Brendan Sheppard: overall supervisor
Hazards
How could someone become hurt or made ill
Control measures
How are you going to prevent this from
happening?
Accidently tripping over loose wires across
the floor
Low
Hazards
How could someone become hurt or made ill
Control measures
How are you going to prevent this from
happening?
Medium
Hazards
How could someone become hurt or made ill
Control measures
How are you going to prevent this from
happening?
Medium
Hazards
How could someone become hurt or made ill
Control measures
How are you going to prevent this from
happening?
low
high
Hazards
Control measures
high
Hazards
Control measures
high