Risk Assessment Form

Athenaeum Centre - Risk Assessment Form
( Please either fill in online or print off and post )

Full Name of Hirer

Contact Name if different from hirer:

Production or Event Title

Item

RISK ASSESSMENT

YES

NO but Follow Up

N/A

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 approved 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
--/--/--	Does the set include 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 ? is the staging the Athenaeum's ?	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	no	n/a
--/--/--	Are all stage fire extinguishers/blankets accessible at all times ?	yes	no	n/a
Orchestra	Are noise levels at all points in the show, 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	no	n/a
--/--/--	Have you allowed a minimum of 1 metre access from the front row ?	yes	no	n/a

Electricals	Are all the brought-in electrical instruments/props etc, PAT tested ?	yes	no	n/a

Costumes	Are costumes made so wearer does not have obscured vision/movement ?	yes	no	n/a

Effects	Are technicians 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 ?	yes	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 any other hazards (list them below) asscoiated with the operation and 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

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

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 2018)

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