.9 lb

Production Name:

Production Address:

Start date

Distribution

Who gets a copy of the assessment

Risk Assessment Form - Part A

Outline of risk assessment

Summary of what is proposed in terms of sequences and set ups.

Team members I experts I contractors I contributors etc. List those involved

Locations

Outline locations involved - indicate any which are hostile environments

4-3 rruro C-" mor

Assessor Date completed Name

Signature

Authoriser

(if not Assessor)

Name

Signature

Date authorised

Hazard list - select your hazards from the list below and use these to complete Part B

'Situational hazards TicK: Physical I chemical hazards Ticl5 . Health hazards . - ··,-1 '-Tick, , '- , - _'",_ - : > ~ .. - .,. ..."._._

Assault by person / Contact with cold liquid / vapour Disease causative agent

Attack by animal Ii Contact with cold surface Infection

Breathing compressed gas Contact with hot liquid / vapour Allergic reaction

Cold environment Contact with hot surface Lack of food / water

Crush by load Electric shock Lack of oxygen

Drowning Explosive blast Physical fatigue

Entanglement in moving machinery Explosive release of stored pressure I Repetitive action

High atmospheric pressure Fire V Static body posture I Hot environment Hazardous substance Stress / anxiety V Manual handling Ionizing radiation Venom poisoning

Object falling, moving or flying Laser light

Obstruction / exposed feature Lightning strike J ~!1,,'{J[.Q_PJ1L~~~~~,,:~ ~~ . ....,~ .. _;.;' i ~ - .. I . ~.~~

Sharp object / material V Noise J Litter

Shot by firearm Non-ionizing radiation Nuisance noise / vibration

Slippery surface Stroboscopic light Physical damage

Trap in moving machinery Vibration Waste substance released into air

Trip hazard ..; Waste substance released into soil/water

Vehicle impact / collision Man~~eriall organisational hazards

Falls from height Management factors (lack of communication, co-operation, co-ordination and competence)

Risk matrix - use this to determine risk for each hazard i.e. 'how bad and how likely' Likelihood of Harm

Likely

Slight e.g. small cut, deep bruise Trivial

Low

Low Low Medium

Possible Very unlikely Unlikely Remote Severity of Harm e.q. <1 in 1000 chance e.g, 1 in 200 chance e.g. 1 in 50 chance e.g. 1 in 10 chance e,g, >1 in 3 chance

Negligible e.g. small bruise Trivial Trivial Trivial Low Low

Moderate e.g. deep cut, torn muscle

Trivial

Severe e. g. fracture, loss of consciousness

Very Severe e.g. death, permanent disability

Low Medium

Trivial

Medium Low

· eOCA TION RELEASE

(~~~e~s~r&,~*vmU~'=Ml~~~20023 Owner hereby grants to St Pauls Catholic College ("Company") and Mr Robert Cranham ("Producer") and their respective parents, subsidiaries and affiliates, licensees, successors and assigns, for good and valuable consideration, receipt of which is hereby acknowledged, permission to enter upon and use the property and the ont ts .e f IJd O. purtenances thereto located at

---1____"~I--'----1..L...:...--L.>...L_'__"-""""""""'-"",""" __ -=-'-"_'_"'--+-'-'""-L.__,,,_, __ (the "P ro perty") for the pu rpose of ph otog raph i ng and recording certain scenes in co ection with a program tentatively titled "AS Media Studies Coursework" ("the Program") during production thereof, and as necessary during any extension, reshooting or preparation of publicity or promotion therefor. All physical embodiments of filming, recording and photography on the Property shall hereinafter be known as the "Materials".

Company and/or Producer may place all necessary facilities and equipment on the Property and agree to remove same after completion of work and leave the property in as good of condition as when received.

Company and/or Producer will use reasonable care to prevent damage to said Property, and will indemnify the owner, and all other parties lawfully in possession, of said Property, and hold each of them harmless from any claims and demands of any person or persons arising out of or based upon personal injuries, death or property damage suffered by such person or persons resulting directly from any act of negligence on Producer and/or Company's part in connection with Producer and/or Company's use of the Property.

Owner grants to Producer and/or Company all rights of every kind in and to the Materials, including without limitation the right to exploit the Materials throughout the world, an unlimited number of times, in perpetuity, in any and all media, now known or hereafter invented, and in connection with the Program, Company or otherwise and for advertising and promotional purposes in connection therewith, and all rights, including copyright, in the Materials shall be and remain vested in Producer and/or Company, and neither Owner, nor any tenant, nor any other party now or hereafter having an interest in the Property shall have any right of action against Producer and/or Company or any other party arising out of any use of said Materials, whether or not such use is, or may be claimed to be, defamatory, untrue or censorable in nature.

The undersigned acknowledges that Producer and/or Company is photographing and recording such scenes in express reliance upon the foregoing. The undersigned represents and warrants that the undersigned has all rights and authority to enter into this agreement and to grant the rights granted hereunder.

Producer and/or Company are not obligated to actually use the Property or produce the Program or include the Materials in the Program for which it was shot or otherwise. Producer and/or Company may at any time elect not to use the Property by giving Owner written notice of such election, in which case neither party shall have any obligation hereunder.

This is the entire agreement. No other authorization is necessary to enable Producer and/or Company to use the Property for the purpose herein contemplated.

AGREED AND ACCEPTED:

BY: rfi (P,;,tName) mecpn :iJllnClLr5

DATE:_b~/2~/~II __