RISK ASSESSMENT FORM

Name:. Project. Dates of working off-campus.. Equipment being used (if any)

Do you need to use this form? This form is an important part of planning any activity that takes place . If you intend to work on any academic or production activity off
campus, please fill out this form and discuss any risks with your tutor. In many cases, there will be no risks that can be identified and only SECTIONS A and C will need to be completed. Where there are risks SECTION B must be completed. Only forms completed to a satisfactory standard and signed by your tutor will be accepted. Please remember that you may not be allowed to proceed with your off-campus activity if this form is not completed.

Section A
A number of potential hazards associated with working off campus are listed below. Examine each in the light of your activity and tick yes or no.

Y 1 2 3 4 5 6 7 8 9 Lone working Cabling Hoists Lighting Explosives/pyrotechnics Smoke Effects Working in poor visibility Scaffolds Working at heights
Y

N
N

Y 10 11 12 13 14 15 16 17 18
Working in/near water

N 19 Caves/tunnel/quarries 20 Stunts 21 22 23 24 25 26 27 Fight sequences Violent interviewees Actors/Performers Child performers Drug Users Criminals Guns/Firearms

Beach/Sand
Vehicles /Traffic

Aircraft
Animals Props

Costumes Glass Electrical Cables/ Pylons

28. Use this space to detail any other potential hazards associated with your assignment

Section B* If you ticked any Y boxes in Section A, then please complete Section B. Hazard no: Risk give further details. ie there is a

risk that... Control what are you doing to minimise the risk? Communicatio n what efforts are you making to communicate the risk to members of the team, the general public etc?

Hazard no: Risk give further details. ie there is a risk that... Control what are you doing to minimise the risk? Communicatio n what efforts are you making to

communicate the risk to members of the team, the general public etc?

Section C The following students are working on this project:

To the best of my belief the information given is correct and complete Signed (STUDENT) _________________________________________________________ _ Date: _______ / ________ / ________
* Please complete Risk Assessment Continuation sheets if additional space is required.

Based on the information supplied, I hereby authorise this activity: Signed (TUTOR) ___________________________________________________________ Date: _______ / ________ / ________