HEALTH AND SAFETY RISK ASSESSMENT FORM

Refer to the H&S Guidance - Risk Assessment for help in completing this form. Assessment Year 1 Factual Unit
Date: Date of shoot
Also see Appendix 1 - Matrix Table Explained to help you to calculate levels of risk. Reference: Documentary assignment
College / Pro-Vice London College of School /
Screen School, LCC Location: Full details of film location/s here
Chancellery: Communication Department:
Risk Assessment Title: Add your Production title here

Description of the task / activity / area: Description of action, interior or exterior, names of contributors involved

Name(s) of Assessor(s): Producer/Production Manager

Risk Owner: Tutor Review Date:

Current risk Revised risk

Who could be
harmed?
What are the hazards?

Likelihood

Likelihood
(e.g. colleagues, Detail any additional control measures

Risk level

Risk level
Severity
Severity
Ref How could they cause harm? What control measures are already
contractors, needed
No. What are the possible in place?
visitors, (add to action plan for implementation)
injuries/illnesses?
passengers,
public)

Crew and contributors encouraged

to take a lateral flow test at home
prior to travelling to the shoot.
Crew to wear facemasks prior to
entering interiors. All who enter
Crew and Add additional control measures here
1 Covid Health & Safety must sanitise their hands using
contributors where appropriate.
sanitiser provided by the
production. Masks to be worn at all
times by contributors prior to
rehearsals and recordings.

Document owner: Health and Safety Version: 2 Last review: January 2019 / Next review: January 2020 Page 1 of 4
 HEALTH AND SAFETY RISK ASSESSMENT FORM
Current risk Revised risk
Who could be
harmed?
What are the hazards?

Likelihood

Likelihood
(e.g. colleagues, Detail any additional control measures

Risk level

Risk level
Severity
Severity
Ref How could they cause harm? What control measures are already
contractors, needed
No. What are the possible in place?
visitors, (add to action plan for implementation)
injuries/illnesses?
passengers,
public)

Risk Owner [mandatory] - I have overall responsibility for the risk assessment. I understand and accept the risks and how they are being managed.

Name: Position: Signature: Date:

If multiple departments are involved in the risk assessment, additional managers may wish to demonstrate their acknowledgement by signing below.

Additional Manager Acknowledgement [optional] - I understand and accept the risks and how they are being managed, relevant to my area of control.

Name: Position: Signature: Date:

Name: Position: Signature: Date:

Name: Position: Signature: Date:

Comments:

ACTION PLAN
Ref No. Action required Responsible person/s Due date Status / date closed

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HEALTH AND SAFETY RISK ASSESSMENT FORM

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 HEALTH AND SAFETY RISK ASSESSMENT FORM

Appendix 1 - Matrix Table Explained

1. Risk rating matrix Severity

Slight harm Moderate harm Extreme harm
(1) (2) (3)
Severe life shortening
Nuisance and irritation, Partial hearing loss,
diseases, permanent
e.g. headaches asthma, ill health leading
Health disability
Temporary ill health to permanent minor
Acute fatal diseases,
leading to discomfort disability
permanent total disability

Lacerations, burns,
Superficial e.g. bruises Multiple injuries, major
concussion, minor
Safety Superficial e.g. minor fractures
fractures e.g.
cuts, eye irritation Fatal injuries
fingers/toes

Isolated or “one off”

occurrence
Unlikely
(1)
Unusual but may VERY LOW LOW MEDIUM
have happened
before
Likelihood

Will probably occur

Likely
(2)
several times a LOW MEDIUM HIGH
year

Very Recurring and

likely frequent, MEDIUM HIGH VERY HIGH
(3) predictable

Calculation of risk
Use the table above to calculate the overall risk level of each hazard identified. Simply use the calculation:
Likelihood (1, 2 or 3) x Severity (1, 2 or 3) to reach your overall risk level. See below for what this means in
practice and what you need to do next.

Very low These risks are considered acceptable. No further action is necessary other than to ensure that the
(1) controls are maintained.
No additional controls are required unless they can be implemented at very low cost (in terms of time,
Low money and effort). Actions to further reduce these risks are assigned low priority. Arrangements
(2) should be made to ensure that the controls are maintained.
Consideration should be given as to whether the risks can be lowered, but the costs of additional risk
reduction measures should be taken into account. The risk reduction measures should be
Medium implemented within a defined time period (usually no greater than within 3 months). Arrangements
(3-4) should be made to ensure that the controls are maintained, particularly if the risk levels are associated
with harmful consequences.
Substantial efforts should be made to reduce the risk. Risk reduction measures should be
implemented urgently within a defined time period (usually no greater than within 1 month) and it
High might be necessary to consider suspending or restricting the activity, or to apply interim risk controls,
(6) until this has been completed. Considerable resources might have to be allocated to additional
controls. Arrangements should be made to ensure that the controls are maintained, particularly if the
risk levels are associated with extremely harmful consequences and very harmful consequences.
These risks are unacceptable. Substantial improvements in risk controls are necessary, so that the
Very high risk is reduced to an acceptable level. The work activity should be halted until risk controls are
(9) implemented that reduce the risk so that it is no longer very high. If it is not possible to reduce risk
the work should remain prohibited. The H&S Team must be consulted.

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