Production / Event Company *
Project / Tour *
Email *
Primary Contact Phone Number *
Secondary Contact Phone Number
Activity 1 * Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address *
Activity 2 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 3 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 4 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 5 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 6 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 7 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 8 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 9 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Activity 10 (if applicable) Animals (working around, handling or riding) Building Construction Site (working in) Climbing/Rappelling Cooking Dancing Drones Extreme Temperatures or Weather Fighting Firearms Investigative/Exploratory Journalism Loud Noise (over 70 decibels) Rigged or Aerial Jumps/Stunts (including choreographed falls, "flying", skydiving, hang gliding and bungee jumping) Special Effects - Hazers/Fog Special Effects - Pyrotechnics/Fire Sports Vehicles (including watercraft, aircraft and automobile) Water Activities (including Diving, Snorkeling, Surfing and Swimming)
Location / Address
Animals: 1. What type of animals are likely to be encountered and how will they be involved in the project? *
Animals: 2. Please list the Animal Handler/Wrangler's [A] # of years of experience with these animals and [B] link to their website or resume *
Animals: 4.a. What animals will they be riding? *
Animals: 4.b. How many years of experience does/will each rider have riding these animals? *
Animals: 4.c. What is the fastest speed (MPH) each rider will be going? *
Animals: 4.d. What safety gear will the riders wear? *
Animals: 6. Please describe the safety precautions being taken to minimize the chance of animals injuring employees on our payroll? (ex. avoiding the animals, handling methods, distance, barriers, protective gear etc.) *
Animals: 8. How many employees on our payroll will be riding, handling or near the animals? *
Construction: 3. Please describe any precautions being taken to avoid accidental injuries: (avoiding certain structures/machinery, work boots, hard hats, eye protection etc.) *
Construction: 4.a. Please describe the surfaces they will be walking on and what precautions are being taken to prevent accidental falls
Construction: 6.a. Please specify which tools/machines they will be using and for what purpose *
Construction: 6.b. Please describe any safety training they will receive or have received prior to using these tools/machines *
Climbing/Rappelling: 1.b. What surface type/size will they be landing on and what is the max speed at which they will land? *
Climbing/Rappelling: 1.c. What devices will be used to control the speed of descent/falls, if any? *
Climbing/Rappelling: 2.b. Can you please provide a short summary of each climber's experience including number of years climbing? *
Climbing/Rappelling: 2.d. How many satellite phones will you have in the event of an emergency?* *
Climbing/Rappelling: 3.a. Please provide the tour or guide company's business name and website.* *
Climbing/Rappelling: 4. Can you please provide a brief description of where/at what height the climbing will begin, progress and end? *
Climbing/Rappelling: 5. Can you please describe what safety gear the participants will be wearing (i.e. helmet, elbow/knee pads, gloves etc.)? *
Cooking: 2.b. Please describe what will take place and what precautions will be taken to prevent injuries:
Dancing: 1.a. Please describe how the stunt will be performed. *
Dancing: 1.b. Please describe any harnessing involved: *
Dancing: 1.c. What height will participants be rappelling from? *
Dancing: 1.d. What surface type/size will they be landing on and what is the max speed at which they will land? *
Dancing: 4. Number of employees participating in this activity?
Drones: 1.b. Please list the Drone Pilot's [A] # of years of experience and [B] link to their website or resume
Extreme Temperatures or Weather: 1. What are the expected temperatures or conditions? *
Extreme Temperatures or Weather: 2. What precautions will be taken or safety gear used to protect against injury or illness? *
Extreme Temperatures or Weather: 3. Where will the extreme temperature or weather exposure take place and how many hours (per day) will employees be exposed to it? *
Fighting: Please describe the type of fighting involved *
Fighting: 2.a. Please describe the type, material, weight and dimensions of the object being used to hit the employee? *
Fighting: 3.a. From what height will the fall take place? *
Fighting: 3.b. What type of padding or surfaces will be used to safely break the falls? *
Fighting: 4. Number of employees participating in this activity? *
Fighting: 5. How many years of experience do the stunt people have performing these stunts? *
Firearms: 1.a. What type of rounds will be used and what precautions will be taken to ensure the safety of employees on our payroll? *
Firearms: 1.b. What type of eye or ear protection will be used by those participating or near the firearm discharge? *
Firearms: 1.c. What type of targets will be used and what precautions will be taken to prevent any injuries from bullet ricocheting? *
Firearms: 2.a. What type of eye or ear protection will be used by those participating or near the firearm discharge? *
Firearms: 3.a. Please describe any protective padding they will wear. *
Firearms: 4. Who is responsible for checking/storing the weapons? *
Firearms: 4.a. Please list the # of years of experience this person has handling firearms and any current certifications held *
Investigative Journalism: 1. What/who is the subject of your investigation/exploration and what is the project intended to reveal/highlight? *
Investigative Journalism: 2. Please describe the interviewer/journalist's experience exploring this particular subject and working under these conditions/circumstances *
Investigative Journalism: 3.a. How long have you worked with this party? If this is a new contact, how were they referred to you? *
Investigative Journalism: 3.b. What experience does this party have investigating or working with this content subject?
Investigative Journalism: 5.a. Please describe the criminal activities they have been convicted of, suspected of, or are involved in *
Investigative Journalism: 7.a. How are interviewees/content subjects vetted/incentivized to ensure the safety of the journalist/interviewer? *
Investigative Journalism: 7.c. How long has the Production or Fixer had a relationship/dialogue with the interviewees/content subjects? *
Investigative Journalism: 9. Are the interviews, interview locations and/or neighborhoods being worked in all scheduled in advance of arrival or will these change as the investigation/exploration develops? *
Investigative Journalism: 10. Please describe any safety procedures or protocols in place to limit potential exposure to dangerous confrontations or situations during interviews/explorations *
Investigative Journalism: 12. How many days are estimated to be spent conducting interviews or recording content subjects? *
Investigative Journalism: 13. How many days are estimated to be spent working in dangerous neighborhoods? (copy) *
Loud Noise: 1. What is the max decibels the sound is expected to reach? *
Loud Noise: 2. What type of ear protection will you use and what is its Noise Reduction Rating (NRR)? *
Rigged or Aerial Jumps/Stunts: Please provide a brief description of the stunt/sequence of events: *
Rigged or Aerial Jumps/Stunts: 1.a. Are participants going Tandem (with a licensed instructor) or solo? *
Rigged or Aerial Jumps/Stunts: 1.c. Please provide the name and website of the company facilitating this activity. *
Rigged or Aerial Jumps/Stunts: 1.d. Please describe the precautions taken by the safety coordinator (or tour company) to prevent improper descent or unsafe landings?
Rigged or Aerial Jumps/Stunts: 2.c. What is the vertical distance (ft) between the jump off point and the landing point? *
Rigged or Aerial Jumps/Stunts: 2.d. What surface type/size will they be landing on and what is the maximum speed at which they will land? *
Rigged or Aerial Jumps/Stunts: 2.e. Will the landing be on a moving surface and require precise timing? *
Rigged or Aerial Jumps/Stunts: 2.g. What is the horizontal distance (ft) they will be jumping (how far will the landing area/pads be from the initial jump point)? *
Rigged or Aerial Jumps/Stunts: 2.h. Please list the Stunt Rigger's [A] # of years of experience rigging these types of stunts and [B] link to their website or resume
Rigged or Aerial Jumps/Stunts: 2.i. Who will be responsible for all winch pulling and creation of rigging points? *
Rigged or Aerial Jumps/Stunts: 2.m. Are the rigging systems designed with a safety back-up in case the operator fails to support the weight? *
Rigged or Aerial Jumps/Stunts: 5. Will the jump/fall start (departure point) and end (landing point) areas be closed off to surrounding foot traffic? *
Special Effect Hazers/Fog: 1. Please describe the special effect, devices and substances involved. *
Special Effect Hazers/Fog: 2.a. Please advise what precautions will be taken to prevent injuries/illnesses? *
Special Effect Pyrotechnics: 1.a. How many times have these employees successfully performed or coordinated these types of activities in the past? *
Special Effect Pyrotechnics: 1.b. Please list any relevant certifications or licenses they hold regarding pyrotechnic safety.
Special Effect Pyrotechnics: 1.c. How many employees on our payroll will be [A] performing stunts and [B] coordinating safety for stunts? *
Special Effect Pyrotechnics: 2.1.1. Which body parts and for how many seconds? *
Special Effect Pyrotechnics: 2.2. How many times will this stunt be performed/attempted? *
Special Effect Pyrotechnics: 3. Please describe the Personal Protective Equipment performers will use to avoid being burned: (gel, water, fireproof clothing/gloves/footwear, eye/head/face coverings, etc.) *
Special Effect Pyrotechnics: 4. What is the expected diameter (in feet) of the flames and what direction will they be traveling relative to where our employees will be? *
Special Effect Pyrotechnics: 5. How far away (in feet) from the flames/pyro will employees on our payroll be positioned? *
Special Effect Pyrotechnics: 6.a. From what height will the fall take place? *
Special Effect Pyrotechnics: 6.b. What type of padding or surfaces will be used to safely break the falls? *
Sports: 1. What type of sports activities will be performed by employees on our payroll? *
Sports: 1.a.1. Please describe the type of physical contact expected between participants: *
Sports: 2. How fast will they be moving? (miles per hour) *
Sports: 3.a. Please describe the stunts and how they will be performed *
Sports: 3.b. If this activity is performed on steep surfaces, what is the slope? (degree of angle) *
Sports: 3.c. How high above the ground will they be? *
Sports: 4. What type of safety gear will be used? (helmets and knee/elbow pads, crash pads/floor mats etc.) *
Sports: 6. Where will this take place? *
Sports: 7. Please describe each participating employee's number of years of experience in this sport (as well as performing any of the scheduled stunts): *
Vehicles: 1.a. Please describe how the vehicle(s) will be used in the project, maximum speeds expected (MPH) and planned maneuvers: *
Underwater Vehicles: 1.b.1. Will they remain in the sub at all times? *
Underwater Vehicles: 1.b.2. What processes or procedures are in place to prevent and treat decompression sickness? *
Underwater Vehicles: 1.b.3. Is this sub custom-built or is it manufactured by a specific company? If so, which company? *
Underwater Vehicles: 1.b.4. Can you please describe the sub's emergency communication method in case of comms loss? *
Underwater Vehicles: 1.b.5. What procedures are in place to resurface in case of power failure or loss of control of the sub? *
Underwater Vehicles: 1.b.6. Is this sub tethered to a surface boat or is it free-moving? *
Vehicles: 2. How many years of experience do the vehicle operators have operating the type of water/air/land vehicle(s) involved and how many times (estimate) have they performed these types of maneuvers? *
Vehicles: 3. Are all vehicle operators licensed or certified (where applicable by local regulations) for the type/class of vehicle they are operating? *
Vehicles: 4.1. Please explain why you are not able to comply with this requirement:* *
Vehicles: 7. If any follow vehicles are involved, how far will they be from the primary vehicle? *
Vehicles: 8.a. For any employees that are Passengers of the vehicle, please list their [A] Full Name and [B] Type of vehicle they will be riding in *
Vehicles: 8.b. For any employees that are Operating the vehicle, please list their [A] Full Name and [B] Type of vehicle they will be operating *
Vehicles: 9. Please describe what safety gear the vehicle(s) or operator(s)/passenger(s) will be quipped with (ex. Vehicle Roll Cage, Vehicle Seat Belts, Plexiglass Windows, Retrofitted Engine/Battery, Life Jackets etc.) *
Water Activities: 1.a. Are all divers PADI certified for these depths and experienced swimming in the scheduled depths? *
Water Activities: 1.b. Where will the nearest recompression chamber be stationed for emergencies? *
Water Activities: 1.c. How many feet below the surface will the diving take place?* *
Water Activities: 1.d. Will each diver be accompanied by a PADI certified safety diver? *
Water Activities: 1.e. Please list the full names of each employee on our payroll that is diving: *
Water Activities: 5.a. What type(s) and species of wildlife are likely to be encountered or involved? *
Water Activities 5.b.1. Please describe the type of bait to be used and how it will be deployed. *
Water Activities 5.c. How close (in feet) will participants get to the wildlife? *
Water Activities 5.d. Will anyone on our payroll be conducting any experiments, tagging, touching, or rendering treatment to the wildlife? *
Water Activities: 6. Please describe the safety precautions being taken to minimize the chance of animals injuring cast or crew? (ex. avoiding the animals, handling methods, distance, barriers, defensive/protective gear etc.) *