First Name:
Last Name:
Age:
Gender:
I Give Permission to use me in your film
Signature:
Date:
|
Production /
Activity
|
Amelia the
film
|
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|
Location
|
Victoria
House
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Date &
Duration
|
27/01/15
|
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|
Description
of Work Activity
|
( including
People at Risk )
|
|||
|
Filming
Amelia the film.
|
Amelia and
Hannah
|
|||
Hazard
|
Hazard
Present
|
DETAILS
|
||
Identification
|
YES |
NO
|
|
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00. Extra Production Equipment (Jib,
Track etc.)
|
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No
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01. Access / Exits
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No
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02. Animals (domestic or wild)
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No
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03. Audiences
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No
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04. Biological Agents / Infection /
Illness / Injury
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No
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05. Cables
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No
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06. Civil Unrest / Crime
|
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No
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07. Confined Spaces
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No
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08. Cranes / Hoists
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No
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09. Derelict Buildings
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No
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10. Electricity or Gas (other than
normal supplies)
|
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No
|
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11. Explosives / Incendiaries
|
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No
|
|
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12. Fire / Flammable Materials
|
|
No
|
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13. Firearms / Weapons
|
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No
|
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14. Flying
|
|
No
|
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15. Hazardous Substances
|
|
No
|
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16. Hazardous Terrain
|
|
No
|
|
|
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17. Heat / Cold / Extreme Weather
|
|
No
|
|
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18. Inexperience
|
|
No
|
|
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19. Lasers / Stroboscopic Effects
|
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No
|
|
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20. Machinery / Industry
|
|
No
|
|
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21. Manual Handling / Lifting
|
|
No
|
|
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22. Night Operations / Difficult
Lighting Conditions
|
|
No
|
|
|
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23. Noise / High Sound Levels
|
|
No
|
|
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24. Personal Protective Equipment
|
|
No
|
|
|
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25. Physical Exertion
|
|
No
|
|
|
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26. Public / Crowds
|
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No
|
|
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27. Pyrotechnics
|
|
No
|
|
|
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28. Radiation
|
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No
|
|
|
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29. Roads / Motorways
|
|
No
|
|
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30. Scaffolds / Rostra
|
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No
|
|
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31. Special Effects
|
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No
|
|
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32. Special Needs (children,
disabilities etc.)
|
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No
|
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33. Specialist Equipment
|
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No
|
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34. Specialist Rescue / First Aid
|
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No
|
|
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35. Stunts / Dangerous Activities
|
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No
|
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36. Transportation
|
|
No
|
|
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37. Tools
|
|
No
|
|
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38. Underwater / Underground
|
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No
|
|
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39. Vehicles / Speed
|
|
No
|
|
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40. Water / Proximity to Water
|
|
No
|
|
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41. Working at Height
|
|
No
|
|
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DATE
|
Scene
|
Int/Ext
Day/Night
|
Shot Descriptions/Summary
|
Location
|
Characters
|
Art Department /Equipment/ Props
|
|
23/01/15
|
1,2,3,4
|
Int/ Night
|
We are going to try and shoot all the
film.
|
Vickys House
|
Amelia and Hannah
|
Talcon Powder, phone, Teddy Bear, long
white t-shirt, phone and suitcase and boxes.
|