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Risk Assessment Form – Part A Blank Template 
Reference: [enter reference number]] Sign-off status [planning/approved etc] 
Assessment summary details 
Assessment title * 
(Simple name for reference 
purposes) 
Alex and Ben music video risk Assessment 
Division:* Production Department:* Media 
Series/ Prod/Unit: Music Video Programme/Area: 
Responsible 
Manager: 
Alex Stickings Contact office: Netherhall School and Sixth Form 
centre. 
Address/Tel: 4 Gunhild Way 
Cambridge 
CB1 8RB 
Address/Tel: Queen Edith’s Way 
CB1 8NN 
01223242931 
Date assessment created 3/11/14 Confidential risk 
assessment? 
NO 
Assessment Outline 
(Summary of what is 
proposed) 
The filming for a music video, to check that the location I am going to use will be safe 
for both cast and the actors. 
Assessment start 
date 
3/11/14 Review / End date 3/11/14 
Country location England Hostile / travel 
advisory? 
No 
Location details Queen Edith’s Way 
CB1 8NN 
NB: If the country location selected is ‘Hostile’ you are 
required to: complete the BBC Overseas High Risk 
Assessment Form 
Crew / team 
(Roles, responsibilities, 
competencies) 
Alex Stickings – Director 
Attachments 
(Detail supporting 
documents) 
Assessor(s) * 
(Person drafting risk 
assessment) 
Alex Stickings and Ben 
Bannister 
Assessor safety 
competence 
Medium 
Authoriser(s) * 
(Person responsible for 
sign-off) 
Mr Sheppard/Mr Day Date signed-off * 
Distribution 
(Who gets a copy of the 
assessment) 
Production Crew 
Data Protection Act: Personal information collected for the purposes of risk assessment will be used to identify those at risk, and 
those involved in controlling risk, from this or similar activities and to fulfil the BBC's obligations under Health and Safety policy and 
legislation. It will be retained for up to 6 years after the expiry of the activity. It may be shared with other organisations, including 
our agents and contractors, with whom the risk or the control of risk is shared. 
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 Activity Risk Rating 
Comments log 
Who by Date / time 
received 
Comments Assessor response Date/ time 
responded 
[* mandatory fields]
Risk Assessment Form – Part B Blank Template 
6Reference: [enter reference number]] Sign-off status [planning/approved etc] 
ACTIVITIES: What are you doing, where, for how long and who will be 
involved? Complete the fields in the form below). 
HAZARDS & CONTROLS: How could someone become hurt or made ill and 
how are you going to prevent this from happening? 
Activity Title:* Setting up in the Studio 
Activity Description: Moving equipment into place. 
List those managing 
this Activity and their 
competence: 
Alex Stickings 
Who & how many are 
at risk from this 
Activity? 
All of the crew and cast members. 
Hazards 
How could someone become hurt or made ill 
Control measures 
How are you going to prevent this from happening? 
Tripping over lighting equipment and other leads in the room. Make sure that everyone is aware of the leads and make sure that all of the leads are taped to the floor 
or to the wall. 
Risk Level*: After your controls have been applied what is your assessment of the risk level of 
this activity? 
Medium 
Add additional activities as required – by copying this section and pasting below 
[* mandatory fields]
Risk Assessment Form – Part B Blank Template 
6Reference: [enter reference number]] Sign-off status [planning/approved etc] 
ACTIVITIES: What are you doing, where, for how long and who will be 
involved? Complete the fields in the form below). 
HAZARDS & CONTROLS: How could someone become hurt or made ill and 
how are you going to prevent this from happening? 
Activity Title:* Lights 
Activity Description: When activating the lights in the studio. 
List those managing 
this Activity and their 
competence: 
Alex Stickings 
Who & how many are 
at risk from this 
Activity? 
All crew and cast members 
Hazards 
How could someone become hurt or made ill 
Control measures 
How are you going to prevent this from happening? 
When the lights come on they will be bright which means there 
is a chance that the cast and crew could hurt their eyes. 
Make sure that there is a warning and make sure that the lights aren’t shining exactly on the members 
face to reduce the chance of eye strain. 
Risk Level*: After your controls have been applied what is your assessment of the risk level of 
this activity? 
Medium 
Add additional activities as required – by copying this section and pasting below 
[* mandatory fields]

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Risk assessment for Media

  • 1. Risk Assessment Form – Part A Blank Template Reference: [enter reference number]] Sign-off status [planning/approved etc] Assessment summary details Assessment title * (Simple name for reference purposes) Alex and Ben music video risk Assessment Division:* Production Department:* Media Series/ Prod/Unit: Music Video Programme/Area: Responsible Manager: Alex Stickings Contact office: Netherhall School and Sixth Form centre. Address/Tel: 4 Gunhild Way Cambridge CB1 8RB Address/Tel: Queen Edith’s Way CB1 8NN 01223242931 Date assessment created 3/11/14 Confidential risk assessment? NO Assessment Outline (Summary of what is proposed) The filming for a music video, to check that the location I am going to use will be safe for both cast and the actors. Assessment start date 3/11/14 Review / End date 3/11/14 Country location England Hostile / travel advisory? No Location details Queen Edith’s Way CB1 8NN NB: If the country location selected is ‘Hostile’ you are required to: complete the BBC Overseas High Risk Assessment Form Crew / team (Roles, responsibilities, competencies) Alex Stickings – Director Attachments (Detail supporting documents) Assessor(s) * (Person drafting risk assessment) Alex Stickings and Ben Bannister Assessor safety competence Medium Authoriser(s) * (Person responsible for sign-off) Mr Sheppard/Mr Day Date signed-off * Distribution (Who gets a copy of the assessment) Production Crew Data Protection Act: Personal information collected for the purposes of risk assessment will be used to identify those at risk, and those involved in controlling risk, from this or similar activities and to fulfil the BBC's obligations under Health and Safety policy and legislation. It will be retained for up to 6 years after the expiry of the activity. It may be shared with other organisations, including our agents and contractors, with whom the risk or the control of risk is shared. 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 Activity Risk Rating Comments log Who by Date / time received Comments Assessor response Date/ time responded [* mandatory fields]
  • 2. Risk Assessment Form – Part B Blank Template 6Reference: [enter reference number]] Sign-off status [planning/approved etc] ACTIVITIES: What are you doing, where, for how long and who will be involved? Complete the fields in the form below). HAZARDS & CONTROLS: How could someone become hurt or made ill and how are you going to prevent this from happening? Activity Title:* Setting up in the Studio Activity Description: Moving equipment into place. List those managing this Activity and their competence: Alex Stickings Who & how many are at risk from this Activity? All of the crew and cast members. Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Tripping over lighting equipment and other leads in the room. Make sure that everyone is aware of the leads and make sure that all of the leads are taped to the floor or to the wall. Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Medium Add additional activities as required – by copying this section and pasting below [* mandatory fields]
  • 3. Risk Assessment Form – Part B Blank Template 6Reference: [enter reference number]] Sign-off status [planning/approved etc] ACTIVITIES: What are you doing, where, for how long and who will be involved? Complete the fields in the form below). HAZARDS & CONTROLS: How could someone become hurt or made ill and how are you going to prevent this from happening? Activity Title:* Lights Activity Description: When activating the lights in the studio. List those managing this Activity and their competence: Alex Stickings Who & how many are at risk from this Activity? All crew and cast members Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? When the lights come on they will be bright which means there is a chance that the cast and crew could hurt their eyes. Make sure that there is a warning and make sure that the lights aren’t shining exactly on the members face to reduce the chance of eye strain. Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Medium Add additional activities as required – by copying this section and pasting below [* mandatory fields]