Athenaeum Centre - Risk Assessment Form
Fill this form in with as much information as you "currently have", we understand that Show content / Scenery may not be assessed until a few weeks before opening night, in which case you should update the information by filling in another form 4 weeks before start date.

   
Full Name of Hirer   Contact Name if not hirer:   Production or Event Title
How many Performances   Dates of Show:   What is it About ?
   
   

 

 

Where relevant please tick only one of the 3 boxes displayed

Fire Retardant

Are all the scenery, costumes and props fire retardant or have they been treated by the technicians? Are all the paints non-flammable emulsion?

    yes
    no
    n/a
 

Scenery

Is all the staging securely fixed to the wall or stage weights ?

    yes
    no
    n/a
 

--/--/--

Has everything on the set been checked to see if it cannot fall or cause injury in any way ?

    yes
    no
    n/a
 

--/--/--

Has your set design been checked by The Trustees ?

    yes
    no
    n/a
 

--/--/--

Have timber/scaffolding members of the scenery been properly assessed for their structural strength ?

    yes
    no
    n/a
 

--/--/--

Has the weight of any timber structure or scaffolding been evenly spread across the stage floor ?

    yes
    no
    n/a
 

--/--/--

Has consideration been made for the risk of falling if the staging includes more than one level, or steps, or is above waist height ?

    yes
    no
    n/a
 

--/--/--

Have you conformed to the legal requirement for all raised staging to have handrails (particularly on ladders)/kick guards/ safety rails?

    yes
    no
    n/a
 

--/--/--

Are the on-stage light levels sufficient at all times to prevent accidents ?

    yes
    no
    n/a
 

Staging

Are you having staging in front of the apron ?

    yes
    no
    n/a
 

Are you using staging belonging to the Athenaeum ?

    yes
    no
    n/a
 

Access

Are all the exit ways from the stage to the backdoor fully clear ?

    yes
    no
    n/a
 

--/--/--

During the performance is access/exit restricted at any point ?

    yes, follow up
    no
    n/a
 

--/--/--

Are all stage fire extinguishers/blankets accessible at all times ?

    yes
    no
    n/a
 

Orchestra

Have noise levels been assessed such that they will not harm cast, audience or those outside ?

    yes
    no
    n/a
 

--/--/--

Are you having a live orchestra or band in front of the apron ?

    yes,follow up
    no
    n/a
 

--/--/--

Have you allowed a minimum of 1 metre access from the front row ?

    yes
    no
    n/a
 

Electricals

Have all brought-in electrical instruments/props etc, been PAT tested & have all exposed steel work in the stage set been equipotential-bonded to the stage main earthing point ?

    yes
    no
    n/a
 

Costumes

Are costumes made so wearer does not have obscured vision/movement ?

    yes
    no
    n/a
 

Effects

Have the Technicians been made aware of any physical and mechanical effects used ?

    yes
    no
    n/a
 

--/--/--

Have you ensured that there are no naked flames in performance ?

    yes
    no
    n/a
 

--/--/--

Have you ensured that any smoke effects are used sparingly with due consideration to the comfort of the audience ?

    yes
    no
    n/a
 

Cast

Have the cast been instructed on procedure in event of an emergency ?

    yes
    no
    n/a
 

--/--/--

Have the cast been instructed that smoking & alchohol are not permitted in the dressing rooms or in the Studio Yard ?

    yes
    no
    n/a
 

--/--/--

Are licences in place for all child cast members ?

    yes
    no
    n/a
 

--/--/--

Are the correct number of child chaperones present for all shows ?

    yes
    no
    n/a
 

--/--/--

Have all cast and crew been informed about not standing in the aisles ?

    yes
    no
    n/a
 

Show

Is there anything in the show that could cause undue alarm/panic? For example; sudden loud noises, firing prop guns, bursting into the auditorium from behind the audience, scenes unsuitable for very young children ?

    yes, follow up
    no
    n/a
 

--/--/--

Has the show been planned to minimise injury risk to cast ?

    yes
    no
    n/a
 

--/--/--

Have you assessed the risk of the cast jumping, or running from the stage, or running in the aisles as part of the performance ?

    yes
    no
    n/a
 

--/--/--

Have you assessed the risk of throwing anything towards the audience sweets/water/paper etc ?

    yes
    no
    n/a
   

        The above is not an exhaustive list and it is the responsibility of the hirer to identify and list below, any other hazards asscoiated with the operation and the set up of the show which could cause harm to the cast, crew, audience or fabric of the building.

Additional Issues & action taken yes no but follow up n/a
These input boxes below allow a maximum of 500 chrs including spaces, if that is not enough then please email us with the full details
 
    yes
    no
    n/a
      yes
    no
    n/a
      yes
    no
    n/a
 
   
Follow Up - was any action taken yes no but follow up n/a
These input boxes below allow a maximum of 500 chrs including spaces, if that is not enough then please email us with the full details
 
    yes
    no
    n/a
      yes
    no
    n/a
      yes
    no
    n/a
 
   
Signed (If submitting form online, a typed signature represents your signature)   Date (eg: 17th July 2022)  
   
 this form or