Theater Production Risk Assessment Form
Assess hazards and mitigation needs for your theater production. Please complete all fields for a thorough risk evaluation.
Production Title
*
Production Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Location of Production
*
Stage Area(s) Assessed
*
Type of Hazard Identified
*
Please Select
Trip/Fall Hazard
Electrical Hazard
Fire Hazard
Mechanical Hazard
Other
Likelihood of Hazard Occurrence
*
1
2
3
4
5
Potential Severity of Hazard
*
1
2
3
4
5
Mitigation Measures Implemented
*
Responsible Person for Mitigation
*
Hazard Assessment Matrix
Rows
Likelihood
Severity
Mitigation Status
Hazard 1
Very Unlikely
Unlikely
Possible
Likely
Very Likely
Insignificant
Minor
Moderate
Major
Critical
Not Started
In Progress
Completed
Hazard 2
Very Unlikely
Unlikely
Possible
Likely
Very Likely
Insignificant
Minor
Moderate
Major
Critical
Not Started
In Progress
Completed
Hazard 3
Very Unlikely
Unlikely
Possible
Likely
Very Likely
Insignificant
Minor
Moderate
Major
Critical
Not Started
In Progress
Completed
Submit Assessment
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