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Risk Assessment Form – Part A 
Reference: None Required Sign-off status Planning 
Assessment summary details 
Assessment title * 
(Simple name for reference 
purposes) 
Music Video – Ciarra and Katie 
Division:* Production Department:* Media 
Series/ Prod/Unit: Music Video Programme/Area: 
Responsible 
Manager: 
Katie Edwards 
Ciarra Graham 
Contact office: Netherhall School and Sixth Form 
Centre 
Address/Tel: 8 Manor Farm Close 
Oakington 
CB24 3AT 
Queen Ediths way 
CB1 8NN 
Address/Tel: Queen Ediths Way 
CB1 8NN 
01223242931 
Date assessment created 20/10/2014 Confidential risk 
assessment? 
NO 
Assessment Outline 
(Summary of what is 
proposed) 
Filming of a music video, checking the locations are safe 
Assessment start 
date 
20/10/2014 Review / End date 
Country location England Hostile / travel 
advisory? 
NO 
Location details Netherhall School Dance 
Studio 
Queen Ediths way 
NB: If the country location selected is ‘Hostile’ you are 
required to: complete the BBC Overseas High Risk 
Assessment Form 
Crew / team 
(Roles, responsibilities, 
competencies) 
Katie Edwards – Director 
Ciarra Graham – Camera 
Attachments 
(Detail supporting 
documents) 
Assessor(s) * 
(Person drafting risk 
assessment) 
Katie Edwards 
Ciarra Graham 
Assessor safety 
competence 
Medium 
Authoriser(s) * 
(Person responsible for 
sign-off) 
Mr Day Date signed-off * 21/10/2014 
Distribution 
(Who gets a copy of the 
assessment) 
Data Protection Act: Personal information collected for the purposes of risk assessment will be used to identify those at risk, and 
those involved in controlling risk, from this or similar activities and to fulfil the BBC's obligations under Health and Safety policy and 
legislation. It will be retained for up to 6 years after the expiry of the activity. It may be shared with other organisations, including 
our agents and contractors, with whom the risk or the control of risk is shared. 
[* mandatory fields]
Risk Assessment Form – Part A 
Activity and Hazard Summary [This is a summary of the activities listed in part B of the risk assessment.] 
Activity Who Exposed Hazards{hazard titles Activity Risk Rating 
Filming in the house Cast and crew · Actors could kick 
the tripod and 
damage is as it is 
a small space 
· Low 
Filming on the street Cast and Crew · People walking by 
could knock to 
tripod and 
damage it 
· Cars passing 
could get 
distracted 
· Crew and cast 
could get hit by a 
car 
· Low 
· Low 
· Medium 
Filming in the dance studio Cast · Our dancer could 
fall and get hurt 
· Medium 
Comments log 
Who by Date / time 
received 
Comments Assessor response Date/ time 
responded 
[* mandatory fields]
Risk Assessment Form – Part B Blank Template 
6Reference: Not required Sign-off status planning 
ACTIVITIES: What are you doing, where, for how long and who will be 
involved? Complete the fields in the form below). 
HAZARDS & CONTROLS: How could someone become hurt or made ill and 
how are you going to prevent this from happening? 
Activity Title:* Dancing in a dance studio 
Activity Description: Our main female actor will be dancing in the school dance studio 
List those managing 
this Activity and their 
competence: 
Kathryn Fisher (dancer) – High competence 
Who & how many are 
at risk from this 
Activity? 
1 
Hazards 
How could someone become hurt or made ill 
Control measures 
How are you going to prevent this from happening? 
Our dancer could fall and injure herself We will make sure that she is sure about what she is doing and she is prepared for the dancing 
Risk Level*: After your controls have been applied what is your assessment of the risk level of 
this activity? 
LOW 
Add additional activities as required – by copying this section and pasting below 
[* mandatory fields]
Risk Assessment Form – Part B Blank Template 
6Reference: Not Required Sign-off status planning 
ACTIVITIES: What are you doing, where, for how long and who will be 
involved? Complete the fields in the form below). 
HAZARDS & CONTROLS: How could someone become hurt or made ill and 
how are you going to prevent this from happening? 
Activity Title:* Filming on the street 
Activity Description: We will be filming a section of the music video on the side of a road 
List those managing 
this Activity and their 
competence: 
Katie Edwards - high 
Ciarra Graham - high 
Who & how many are 
at risk from this 
Activity? 
3 people are at risk (Katie, Ciarra and Kathryn) 
Hazards 
How could someone become hurt or made ill 
Control measures 
How are you going to prevent this from happening? 
A car could get distracted by our filming We will make sure we film these parts relatively so we don’t distract mat cars 
One of the cast or crew could get hit by a passing car We will make sure we are all aware of our surroundings and that we wont step out near to the road 
Risk Level*: After your controls have been applied what is your assessment of the risk level of 
this activity? 
Medium 
Add additional activities as required – by copying this section and pasting below 
[* mandatory fields]

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Risk Assessment Form for Music Video Filming

  • 1. Risk Assessment Form – Part A Reference: None Required Sign-off status Planning Assessment summary details Assessment title * (Simple name for reference purposes) Music Video – Ciarra and Katie Division:* Production Department:* Media Series/ Prod/Unit: Music Video Programme/Area: Responsible Manager: Katie Edwards Ciarra Graham Contact office: Netherhall School and Sixth Form Centre Address/Tel: 8 Manor Farm Close Oakington CB24 3AT Queen Ediths way CB1 8NN Address/Tel: Queen Ediths Way CB1 8NN 01223242931 Date assessment created 20/10/2014 Confidential risk assessment? NO Assessment Outline (Summary of what is proposed) Filming of a music video, checking the locations are safe Assessment start date 20/10/2014 Review / End date Country location England Hostile / travel advisory? NO Location details Netherhall School Dance Studio Queen Ediths way NB: If the country location selected is ‘Hostile’ you are required to: complete the BBC Overseas High Risk Assessment Form Crew / team (Roles, responsibilities, competencies) Katie Edwards – Director Ciarra Graham – Camera Attachments (Detail supporting documents) Assessor(s) * (Person drafting risk assessment) Katie Edwards Ciarra Graham Assessor safety competence Medium Authoriser(s) * (Person responsible for sign-off) Mr Day Date signed-off * 21/10/2014 Distribution (Who gets a copy of the assessment) Data Protection Act: Personal information collected for the purposes of risk assessment will be used to identify those at risk, and those involved in controlling risk, from this or similar activities and to fulfil the BBC's obligations under Health and Safety policy and legislation. It will be retained for up to 6 years after the expiry of the activity. It may be shared with other organisations, including our agents and contractors, with whom the risk or the control of risk is shared. [* mandatory fields]
  • 2. Risk Assessment Form – Part A Activity and Hazard Summary [This is a summary of the activities listed in part B of the risk assessment.] Activity Who Exposed Hazards{hazard titles Activity Risk Rating Filming in the house Cast and crew · Actors could kick the tripod and damage is as it is a small space · Low Filming on the street Cast and Crew · People walking by could knock to tripod and damage it · Cars passing could get distracted · Crew and cast could get hit by a car · Low · Low · Medium Filming in the dance studio Cast · Our dancer could fall and get hurt · Medium Comments log Who by Date / time received Comments Assessor response Date/ time responded [* mandatory fields]
  • 3. Risk Assessment Form – Part B Blank Template 6Reference: Not required Sign-off status planning ACTIVITIES: What are you doing, where, for how long and who will be involved? Complete the fields in the form below). HAZARDS & CONTROLS: How could someone become hurt or made ill and how are you going to prevent this from happening? Activity Title:* Dancing in a dance studio Activity Description: Our main female actor will be dancing in the school dance studio List those managing this Activity and their competence: Kathryn Fisher (dancer) – High competence Who & how many are at risk from this Activity? 1 Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? Our dancer could fall and injure herself We will make sure that she is sure about what she is doing and she is prepared for the dancing Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? LOW Add additional activities as required – by copying this section and pasting below [* mandatory fields]
  • 4. Risk Assessment Form – Part B Blank Template 6Reference: Not Required Sign-off status planning ACTIVITIES: What are you doing, where, for how long and who will be involved? Complete the fields in the form below). HAZARDS & CONTROLS: How could someone become hurt or made ill and how are you going to prevent this from happening? Activity Title:* Filming on the street Activity Description: We will be filming a section of the music video on the side of a road List those managing this Activity and their competence: Katie Edwards - high Ciarra Graham - high Who & how many are at risk from this Activity? 3 people are at risk (Katie, Ciarra and Kathryn) Hazards How could someone become hurt or made ill Control measures How are you going to prevent this from happening? A car could get distracted by our filming We will make sure we film these parts relatively so we don’t distract mat cars One of the cast or crew could get hit by a passing car We will make sure we are all aware of our surroundings and that we wont step out near to the road Risk Level*: After your controls have been applied what is your assessment of the risk level of this activity? Medium Add additional activities as required – by copying this section and pasting below [* mandatory fields]