FORM RA 002 (adapted for Student Media Productions)

Equipment booking

Name of hirer Fabian Viles

Facility / equipment required

Catalogue Description Hours/days Unit Cost
code cost
XA25 Tripod arm (Possible) 1 day
Possible Boom Mic 1 day

Total

Date Time
Issue 1/05/2019 14:40
Return 2/05/2019 12:00

Please give as much notice as possible. Location filming requests MUST be submitted at least
48 hours in advance to ensure batteries can be charged etc.

Page 1 of 8
 FORM RA 002 (adapted for Student Media Productions)

Call sheet

Production title Final Project

Call sheet for (date)

Production team
Names Roles Contact details
Adam Camera Operator xxxxxxxxxxx

Actors
Fabian Viles Xxxxxxxxxxx
Becky Xxxxxxxxxxx
First aider

Base address and contact details: Fynamore Gardens, Calne, SN11

xxxxxxxxxxx

Location address: 3 Beach Terrace, Calne, SN11 0RD

Map attached.

Access info: has be arranged

Contact details:01249812508

Travel arrangements: has be arranged

Times
Meet time at base

On location 3:20

Shoot time (s) and scene numbers 1

Planned breaks and catering arrangements 0

Projected wrap time 5:00

Back at base time 5:30

Weather report (if outside)

N/A inside

Page 2 of 8
 FORM RA 002 (adapted for Student Media Productions)
Special considerations with regard to location/weather/activities etc

Page 3 of 8
 FORM RA 002 (adapted for Student Media Productions)

RISK ASSESSMENT FOR LOCATION DATE OF

1st may
ACTIVITY
FILMING
TASK / ACTIVITY film final project DATE
17th may
ASSESSED

BRIEF DESCRIPTION blind date in café

See Risk Assessment Assistant (Page 3) for scoring.

RISK RATING
(likelihood × consequence = )
Include the risk ‘word’ (i.e. acceptable, adequate, tolerable, unacceptable).

PEOPLE NUMBER OF PEOPLE UNDERTAKING TASK

DURATION OF TASK
PERSONNEL PROFILE / TRAINING GIVEN

PERSONNEL INSTRUCTED PERSONNEL INSTRUCTED PERSONNEL INSTRUCTED

STAFF 4 TALENT 2 YOUNG PERSON 0

STUDENT 3 CONTRIBUTORS 3 VISITOR 0

PERSONNEL
PUBLIC Unknown
WORKING ALONE

SPECIALIST
DISABLED 1 TRAINED
PERSONNEL

CONTROL MEASURES IN PLACE (Guarding, Safe Systems of Work, PPE, etc)

TO BE COMPLETED BY STAFF ASSESSOR(S) (Ctrl+Tab to add tab stops between columns)

EXTRA ACTIONS REQUIRED TO CONTROL SIGINIFICANT RISKS ACTIONED BY DATE

STUDENT ASSESSOR(S)

STAFF ASSESSOR(S)

Page 4 of 8
 FORM RA 001
ACTIVITY / TASK
HAZARD IDENTIFICATION
HAZARD TYPE PRESENT HAZARD TYPE PRESENT
COMMENTS COMMENTS
1. Mechanical / Physical Hazards YES NO 4. Production Hazards YES NO

1.1 Slips / Trips / Falls yes Tables and chairs 4.1 Stressful Postures no

1.2 Vehicles no 4.2 Lifting / Handling no

1.3 Camera Grip Equipment yes Tripod 4.3 Inadequate Breaks yes No breaks. Short film time

1.4 Falling Equipment no 4.4 Restricted Visibility (viewfinder) no

Tracking shots inside and

1.x Other Mechanical Hazards no 4.5 Camera Tracking/Crabbing yes
outside.

2. Electrical Hazards YES NO COMMENTS 4.6 Working at Height yes Single high angle shot of cafe

Display cabinet. Tables and

2.1 Direct Contact no 4.x Other Workplace Hazards yes
chairs.

2.2 Indirect Contact yes Camera wises and display 5. Hazardous Substances YES NO COMMENTS

2.3 Short Circuit / Overload no 5.1 Explosive / Biological / Chemical no

2.4 Source of Ignition no 5.2 Substances in set construction no

2.5 Proximity to Water yes Water on table 5.x Other Hazardous Substances no

3. Production Activities YES NO 6. Environmental Hazards YES NO COMMENTS

3.1 Extreme Sports no 6.1 Localised Hot / Cold Surfaces yes Around café behind counter

3.2 Animals (working with or proximity to) no 6.2 High / Low Ambient Temp. No

3.3 Fight sequences no 6.3 Poor Lighting No

3.4 Potential Intervention from Public yes Pubic around and inside the café 6.4 Confined spaces yes Café is small

3.5 Potential for Assault no 6.5 Poor Weather No

Page 5 of 8
 FORM RA 001
3.6 Noise pollution yes Possibility 6.6 Uneven/Slippery Surfaces No

3.7 Smoking yes Oissibility 6.7 Unsafe structures No

3.8 Alcohol no 6.8 Sharps & breakages No

3.x Other Production Activity Hazards no 6.x Other Environmental Hazards No

Page 6 of 8
 FORM RA 001

RISK ASSESSMENT ASSISTANT

These are the basic terms that apply to a Risk Assessment:

A hazard is anything that has the potential to cause harm. This could be something as specialised as a piece of
complicated machinery, or as commonplace as a cup of coffee. If it could be harmful in any way, then it’s a
hazard.

A hazardous event takes place when someone or something interacts with the hazard and allows it to cause
harm. Take a hole in the ground for example. The hole (the hazard), by itself isn’t causing any harm, but if
someone tripped over it (the hazardous event) then it would become harmful. Every hazardous event has a
likelihood and a consequence.

Likelihood is a measure of the chance that the hazardous event will occur. If the hole is in a busy area, such as
a shop entrance, it’s more likely someone will trip over it. However if it’s in an area that doesn’t get a lot of traffic,
such as a back yard, tripping over it would be less likely.

The consequence is the outcome of the hazardous event. If you tripped over a hole, there could be several
possible outcomes; you might land on your feet with no damage at all, you might drop whatever you are carrying,
or perhaps you could end up with a sprained ankle or even a fracture.

Risk is the combination of the likelihood of a hazardous event occurring and the consequence of the event.

Risk = likelihood x consequence

Below is a table to help you work out the score for the likelihood and consequence. Once you have
done this, multiply the two numbers to get the Risk Rating.

Risk
Likelihood Consequence
Score
Very unlikely – might happen once in 5 years 1 No injury

Unlikely – would not happen in 2-3 years 2 Minor - minor injury requiring first aid

Fairly Likely – would expect to happen once a year 3 Moderate - up to three days’ absence

Likely – could occur 2-3 times a year 4 Major – more than three days’ absence

Very Likely – likely to happen 2-3 times a week 5 Catastrophic – Death or multiple deaths

Risk Matrix – this is used for estimating and evaluating the risk it is a commonly used tool. Usually the higher the
risk level, the more serious the risk and the more likely you’ll need to take action.

Page 7 of 8
 FORM RA 001

UNACCEPTABLE – Stop the activity and make

5 10 15immediate
20 improvements
25
17-25
 CONSEQUENCE 

4 8 12 16 20

3 6 9 TOLERABLE
12 15– look to improve within a specified
timescale 10-16
2 4 6 8 10

1 2 3 4 5
ADEQUATE – Look to improve at next review
 LIKELIHOOD 
5-9

1-5

If you are still not sure or just have a question, please do not hesitate in contacting the Health & Safety
Department – We are here to help!

Page 8 of 8