Full Name of Hirer | Contact Name if not hirer: | Production or Event Title |
How many Performances | Dates of Show: | What is it About ? |
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Where relevant please tick only one of the 3 boxes displayed |
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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 |
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 |
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yes |
no |
n/a |
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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 |
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yes |
no |
n/a |
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yes |
no |
n/a |
Signed (If submitting form online, a typed signature represents your signature) | Date (eg: 17th July 2022) |