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| | Hazard | Present? | Severity | Likelihood | Risk factor |
| 1 | Alcohol / drugs | No | | | |
| 2 | Animals / insects | No | | | |
| 3 | Audiences | No | | | |
| 4 | Camera cable / grip equipment | Yes | N | L | 2 |
| 5 | Confined spaces | No | | | |
| 6 | Derelict buildings / dangerous structures | No | | | |
| 7 | Electricity / gas (other than normal supplies) | No | | | |
| 8 | Fatigue / long hours | No | | | |
| 9 | Fire / flammable materials | Yes | V | U | 4 |
| 10 | Hazardous substances | No | | | |
| 11 | Heat / cold / extreme weather | No | | | |
| 12 | Laser /strobe effects | No | | | |
| 13 | Machinery: industrial crane / hoist | No | | | |
| 14 | Materials: glass, non-fire-retardant | No | | | |
| 15 | Night operation | No | | | |
| 16 | Noise: high sound levels | No | | | |
| 17 | Non-standard manual handling | No | | | |
| 18 | Public / crowds | No | | | |
| 19 | Radiation | No | | | |
| 20 | Scaffold / rostra | No | | | |
| 21 | Smoking on set | No | | | |
| 22 | Special effects / explosives | No | | | |
| 23 | Special needs: elderly, disabled etc | No | | | |
| 24 | Specialised rescue / first aid | No | | | |
| 25 | Stunts, dangerous activities | No | | | |
| 26 | Tall scenery / suspended ceilings | No | | | |
| 27 | Vehicles / speed / traffic | No | | | |
| 28 | Water / proximity to water | No | | | |
| 29 | Weapons | No | | | |
| 30 | Working at heights | No | | | |
| 31 | Working overseas | No | | | |
| 32 | Food and drink: on set / prop food and drink | No | | | |
| 33 | Other risks | No | | | |
Hazard Number | [No.] 4 | Risk Factor (1-5) | [2] 1 | |||||||||||
| Description | Potential hazard regarding cables and props on set | |||||||||||||
| Person(s) exposed | Cast and crew | |||||||||||||
| Action to take | All cables are secure and out of reach Precautions to be taken when handling props around equipment | |||||||||||||
| Person / company responsible for action | Crew | |||||||||||||
| To be completed by [date set above] | ||||||||||||||
| Exposed person(s) informed? | Agreed action taken? | Risk removed? | ||||||||||||
| Yes | x | No | | Yes | x | No | | Yes | x | No | | |||
Hazard Number | [No.]9 | Risk Factor (1-5) | [No.]4 | ||
| Description | Fire/flammable materials | ||||
| Person(s) exposed | Cast and crew | ||||
| Action to take | No liquids are in the areas that can cause fire, and no flammable liquids present whilst filming. | ||||
| Person / company responsible for action | Crew | ||||
| To be completed by [date set above] | |||||
| Exposed person(s) informed? | Agreed action taken? | Risk removed? | |||
| Completed by: [Name] Verity Wakeford | Position: [Location manager or Producer] |
| Signature verity wakeford | Date: [15/11/2010] |
| Countersigned by: [Name] | Position: [Producer] |
| A Stafford | Date: [15 /11/2010] |
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