Department of Media Arts
Location Safety Form
Directed Performances
1. Production and crew information
Production Title:
Your name:
Your practice course:
Your mobile number:
Your tutor:
Your crew
Name:
Contact No. (mob)
Name:
Contact No. (mob)
2. Who and what is being filmed?
List actors, extras, or
participants in the
scene
Please identify any child or young actors or other participants who have yet to reach the Minimum School Leaving Age
(i.e. end of school year in which they reach 16 years of age) and supply evidence that (1) you have contacted their Local
Authority to obtain licensing exemption and (2) you have consent from their parent(s) or guardian(s) for them to appear
in your film. You will need to state in your risk assessment how they will be supervised during filming, in accordance
with legal requirements
Describe the type of
action you plan to
film, including
significant
movement of actors
and cameras around
the set
List props, costumes
and other items
required in the scene
Describe any
specialist safety
advice you have
already been given
regarding the action,
use of prop weapons,
performance of
stunts, etc.
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3. Your film location
General type of location (e.g. street, station, living room, kitchen,
café, etc.)
Scene is INT or EXT?
Scene is Day or Night?
Location contact details
(name, status, address, telephone, email):
If filming in rented accommodation, please give contact details for
the relevant landlord or their managing agent, and supply evidence
that written permission has been obtained.
If filming in the street (i.e. on the public highway, including the
pavement, roadside, pedestrian precincts, etc.,) please state the
relevant film office contact and supply evidence that written
permission has been obtained.
For street filming you also need to notify the Police – please supply
details including the Police station that you notified, the date and
time of your call, the name of the Police Officer you spoke to and
any reference number you were given.
If filming in other spaces open to the public, including parks, railway
stations, airports, waterways, museums, galleries, theatres,
venues, clubs, pubs, etc, please supply the relevant contact details
and supply evidence that written permission has been obtained.
If filming in or on private property, including any College facilities,
private houses, businesses, educational establishments, farms, etc.,
please supply contact details and evidence that filming permission
has been obtained.
Location address
Agreed shoot date
Agreed arrival time:
Agreed ‘clear out by’ time:
Date tech recce was completed:
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Describe the location’s operating conditions
Travel
Nearest rail or tube station:
Nearest bus stops:
Equipment loading
access
Parking / Loading
access permission
obtained?:
Members of the public or
other people who may be
affected by the filming
Work facilities – food &
drink, changing,
lavatories, secure
storage, etc.
Sound recording issues
Available light issues
Fire and similar emergencies
(You must consider this whenever there is a possibility of persons becoming trapped)
Identify your designated fire exit routes
(these must be unlocked and clear of
obstruction at all times)
Identify your fire assembly point
Identify the person responsible for checking
that everyone involved has gone to the
assembly point
How will you communicate this information
to everyone involved in the filming?
Emergency care
In the event of injury or serious illness occurring during the filming work, call the following numbers:
For potentially life-threatening emergencies call 999
When you need medical help fast but it's not a 999 emergency, call 111
If the person suffering is a student and they are unable to contact their next of kin, call the College Security Services (24hr service) on 01784
443063 and supply details so that these may be conveyed by the College.
All accidents and incidents with potential to cause injury must be reported as soon as possible to the Department Office and an
Accident/incident Report Form completed.
If you are contacted by the press or media in relation to the incident, you should not answer questions but refer enquiries to
the College Press Office on 01784 443967.
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4. Your Safety Risk Assessment
Hazard
Who is at risk?
How might they be harmed?
Chance of
injury
Severity of
injury
Injury while lifting and
carrying
-
-
Slipping or tripping
-
-
Causing a public
transport incident
-
-
Accidents occurring
while driving
-
-
Exposure to electrical
hazards
-
-
Accidents during any
roadside working
-
-
Fire hazards
-
-
Exposure to adverse
weather conditions
-
-
Dangerous terrain
-
-
Potential to obstruct
emergency exits
-
-
Potential to obstruct
passageways
-
-
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Control measures that will be
implemented
Falling from height
-
-
Set, props or equipment
toppling onto persons
-
-
Using ladders, steps and
other access equipment
-
-
Objects falling onto
work area from above
-
-
Dropping objects onto
people below work area
-
-
Night working, dim
lighting, etc
-
-
Trapping or burning
hands
-
-
Exposure to excessive
sound levels
-
-
Working in or near water
-
-
Working alone
-
-
Working in a public
space
-
-
Working with children
and young persons
-
-
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Risk of personal assault
or abuse
-
-
Exposure to
uncontrolled animals
-
-
Contact with harmful
plants
-
-
Broken glass and other
sharp objects
-
-
Exposure to harmful
gasses, vapours, etc
-
-
Exposure to harmful
fluids
-
-
Scenes involving
weapons
-
-
Work method statement required
Scenes involving
smoking
-
-
Work method statement required
Scenes involving
vehicles
-
-
Work method statement required
Scenes involving staged
conflicts
-
-
Work method statement required
Scenes involving mobile
grip equipment
-
-
Work method statement may be required
Other hazards not
identified above (please
specify)
-
-
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5. Equipment
Please list all items of equipment you intend to use for this shoot (whether booked through the Location Store or supplying
your own or hired/borrowed equipment). This information will enable your tutor to envisage potential safety issues. Please
note this is not an equipment booking and you need to visit the Location Store once your form is approved.
6. Declaration
By sending this form to your course tutor, you are effectively signing the following declaration:
‘I hereby state that I have been trained by the Department of Media Arts in location safety risk assessment and take full
responsibility for implementing appropriate safety precautions for this recording, as described in this form, which is to the
best of my knowledge accurate and complete. I have also obtained the necessary permissions to record as set out above and
can provide written evidence on demand. Furthermore, if the actual safety risks are found to be higher than expected, I will
suspend all recording activity and seek instruction from my course tutor.’
Your course tutor will either contact you to query any aspects of your form, or approve the form by sending it to the Location Store.
Once your form is approved, you must ensure that any significant safety risks, and their associated control measures, are
effectively communicated to anyone that may be affected by them.
You must keep a copy of this form in your production papers and be prepared to show or send copies to interested parties, such as
location contacts, local authorities, police officers, Royal Holloway staff, HSE officials, etc., as required.
Location Store contact information
Email: locationsafety.media-arts@rhul.ac.uk
Tel: 01784 443733
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