Location Permission Form

I ________________ hereby give permission to Cryptic Productions

to film at
17 London Road, Buckingham, MK18 1AR
On 21st January 2015
I understand and approve of the footage to be used for the student
movie: Disturbance and agree for the location to be used on the
provision that neither the location nor its owners are
misrepresented.

Signed:
PRINT NAME:
DATE:

RISK ASSESSMENT
NAME AND ADDRESS OF ASSESOR: Daniel Brewer

Location address:
17 London Road
Buckingham
MK18 1AR
Risk description
Water

Date of assessment:
15/12/14

Risk [1-5]
1

Severity [1-5]
1

Heights / stairs

Public

Prevention of risk
Mop up all puddles
Have wet floor signs
Notify staff and cast of any water on floor.
Advice cast and staff stays on ground floor of
set, if required to use stairs use the handrail
and take them one step at a time.
There will be no high shots so cast and crew
will be on ground level at all times.
The public (residents of building) will most
likely not be in. If so they will be notified when
the camera is rolling to prevent disruption.
Other than residents, there will be no
members of public as building is a personal
residence.

Electricity and
equipment

Open flames

Transport

Knives will be used as a prop and therefore

could be lethal if acting is absurd.
To prevent we will remind all knife wielders
that the handle is to be held and the blade
should not make contact with skin or clothing.
When not in use knives will be replaced into
their accommodation
All cast and crew will be alerted of an open
flame and are advised at all times to keep 2
metres away from a flame.
If flames get out of control, a member of the
crew will douse them. Cast are not to
approach.
Transportation will depend on the cast / crew.
However all cast and crew have been informed
that they are responsible for managing their
own safety until on set.
All cast will have been advised to travel with a
trusted driver.

Local hospital:

Address and phone number:

Milton Keynes Hospital

Standing Way
Eaglestone
Milton Keynes, Buckinghamshire MK6 5LD
01908 660033

Local police:
Thames Valley Police

Address and phone number:

In Emergency 999
Non Emergency 0845 8 505 505

Declaration that location has been assessed for risk and safety risks and precautions have been
considered.
Signed:

Location recci
Location for: Home Scenes
Potential location: photo and address
18 Waine Close, Buckingham, MK18 1FG

Positives and negatives about location

Positives
Negatives
- Cheap Cast
- Home to loud Dogs.
Members Home
Will have to work
around
- Large Area of Space
- 2 Residents who are
- Convenient for cast
not involved in
and employees
production could be in
way on set
- Drawer placement is
perfect for Rose to
- Location is too large,
reach behind and grab (Image 2) would not
a knife to kill her
be logical for the plot.
boyfriend.
- Set has an orange
- Only one window to
like tint (Image 1
allow in natural light
Window) (Image 2)
(image1)

17 London Road, Buckingham, MK18 1AR

Positives
- Cheap Cast
Members Home
- Large Area of Space
for equipment (Image
3)
- Convenient for cast
and employees
- Due to shooting time
and date residents will
be out
- Only one dog, who is
quiet (no barking)
-Kitchen is perfect size
for the scene as
Rose would not be

Negatives
- Although Dog is
silent, may be
inquisitive and walk
into frame as its bed
is in kitchen (Image 3)
- Residents could be at
home during
recording could have
un-necessary non
diagetic sounds and
interruptions
-Potential lighting
problem (image 3)
there is a large
windowed door,
which will allow
sunlight in, and when
sun is in correct place

able to simply escape

(image 2)

could cause lens flares

whilst recording. This
is further increased
with the window
(image 2)

Conclusion: The location at 17 London Road will be used as there will be less off screen distractions
and the size is relevant for the situation and logical as Rose will not be able to simply run away

RISK ASSESSMENT
NAME AND ADDRESS OF ASSESOR: Daniel Brewer

Location address:
Buckingham
Ford Street and Chandos Walkway
MK18 1AF

Risk description
Water

Date of assessment:
17/12/14

Risk [1-5]

Severity [1-5]

Electricity and
equipment

Open flames

Heights / stairs

Public

Prevention of risk
As filming outside cast members will be made
aware of puddles and are warned that any
puddles could be frozen over depending on
weather. Additionally at Chandos walkway
Rose will be running next to a river and
therefore there is a risk of tripping, rolling and
falling in the river. The actress for Rose will
be warned of this risk and advised to run on
the opposite side of the pathway than the river
side
All filming will be done on ground level outside
so no risk of stairs. However, Rose will be
running slightly uphill and downhill in the two
locations and could trip. So they are advised to
survey the route first to be familiar with
potential obstacles
As filming in a public place there is the
opportunity for members of public to be in the
shot, and therefore multiple takes will be
needed. For prevention, shooting would need
to occur at the height of the working day.

Due to filming in public there will be no

electrical risk. In terms of equipment, they will
be placed on the grassy bank(s) available to
prevent the actress and cast from tripping over
them. All cast and crew will be told of
equipment location to avoid any potential
casualties. Additionally they will be placed out
of the way so members of public cannot cause
harm to themselves
There is a highly unlikely chance that there will
be an open flame as shooting will be in public
so an open flame could cause a small inferno.
Therefore all cast and crew are advised to stay

away from the blaze and call 999 for the Fire
Service.
Transport

Transportation will depend on the cast / crew.

However all cast and crew have been informed
that they are responsible for managing their
own safety until on set.
All cast will have been advised to travel with a
trusted driver.

Local hospital:

Address and phone number:

Milton Keynes Hospital

Standing Way
Eaglestone
Milton Keynes, Buckinghamshire MK6 5LD
01908 660033

Local police:
Thames Valley Police

Address and phone number:

In Emergency 999
Non Emergency 0845 8 505 505

Declaration that location has been assessed for risk and safety risks and precautions have been
considered.
Signed:

Location recci
Location for: Running Scenes
Potential location: photo and address
Ford Street, Buckingham, MK18 1AF

Positives and negatives about location

Positives
Negatives
- All traffic (if any) will
Cheap Public Place
be pedestrians will
need permission from
No permissions
each of them to be in
needed for filming at
finished product. If
location
not will have to reshoot shot
Concealed, not much
traffic going through.
Small decline then is
flat ground, easy for
Rose to run down

Chandos Park Walkway, Along Side Great River

Ouse (Buckingham)

Positives
Small tight walkway,
connotation of
isolation.
Easy to access from
previous location.
Is a public place so
there is no cost to
record footage.
No permissions
needed for filming at
location

- Close to main road

(top image)
opportunity for unrequired non diagetic
sound

Negatives
Public pathway that
joins park to town,
potential pedestrians
who cannot be in
shoot. So shots will
have to be taken by
opportunity
Close to park and play
area, un needed non
diagetic sounds from
children
As shown in Image 2,
depending on the
time of day and
camera angle there is
a risk of lens flares.

Conclusion: Both locations will be used but in different shots as it will give the feel as though Rose
is actually running from the police and therefore having two locations that are connected will give a
more realistic feel for the local audience.