Name of Hirer | Email Address | 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 and/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 |
Food & Drink |
Are you planning to serve, or sell your own food or drink - including any cakes, snacks or refreshments? |
yes food |
yes drink |
n/a |
Children |
Are you planning to have child performers in your production? if YES, you will need to comply with our special notices relating to child protection and school productions, ask for details, or visit our website links below.
|
yes children |
Number of Children |
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 , and instructed on food usage and disposal. ? |
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 and rehearsals ? |
yes |
no |
n/a |
--/--/-- |
Have all cast and crew been informed about not standing in the aisles, or using the aisle as extensions of the stage activity ? |
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 |
|||||
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) |