APPROVED BY TUTOR: Film & TV Production APPROVED BY TUTOR: Equipment Booking Form USERNAME: billy.dixon Kit Number:Technical Team Only Add in here a complete list of the Locations with Dates and indicate Documentation covered by this booking. Your Module Tutor will check this against the documentation provided on the Crew and Production Paperwork section. Collection and return times may be amended by the technical team at the point of handing paperwork in at the Hatch (this is to be done 48hrs prior to the collection date). Collection date: 23/03/2015 Return date: 23/03/2015 Location Name: Date: Studio one 23/03/2015 Equipment Camera (Canon 70D) Camera battery Tripod Clapper board & pen Other Items: Number 1 2 1 1 Role/s Crew Member Name Billy Dixon Matthew McDermott Liam TaylorRutterford Producer/Researcher Camera Operator (Back Up) Collection time: 9:00am Return time: 12:00 am Issued Returned Telephone RiskA ✔ LocA ✔ Other: (state) Problems/Faults/Damage Email 07553063115 07950404546 [email protected] [email protected] 07964680590 [email protected] In order for a booking to be signed off by your Module Tutor and accepted by the Technical Team, all the roles being undertaken by individual Crew Members must be stated below, including the role booking out the equipment. This is to ensure that the right Crew Members are collecting the right kit for their shoot. It also provides the Technical Team with contact details, should there be any issue with the provision of equipment or technical problems with what has been provided. Only YSJ email accounts should be used for module work. If you are called by a different name from your email account, put this in brackets. I hereby undertake with the Governors of the University of York St John the following: - That I am a student of York St John University and Member of the Crew as stated above; To retain the Equipment in my exclusive possession and control during the period of loan; To use the equipment only for activities agreed with my Module Tutors and in accordance with the conditions set out below; That Risk Assessment Forms have been prepared to support the appropriate use of this equipment at the specific times and locations covered by this booking, and that these have been approved and agreed with my Module Tutors; I do not foresee any significant hazards other than those noted; I have carefully considered all the production activities and the findings of the Risk Assessment attached, and further communicated these findings to the production group and others who may be affected e.g. site owners, engineers, contractors, freelancers, resources, etc.; I and other crew members have attended technical demonstrations which provided training in the use of the equipment and Health & Safety considerations; - That only trained students or staff of York St John University will be using this equipment (students MUST have relevant stamps on their production card); - On being issued, to check that I have received the agreed equipment and that it is in appropriate working order; - Fair wear and tear accepted. To keep the Equipment in its condition at the date hereof; - To notify the Technical Team of any faults, problems or damage to the Equipment; - To indemnify the University in the respect of any loss or damage to Print Name: Billy Dixon the Equipment or any part thereof howsoever and by whosoever caused during the period of loan; - To return the Equipment to the University forthwith upon demand being Signature: made and in the event not later than the return date and time specified above. Those responsible for specialist equipment must sign in the appropriate place below to identify themselves as both trained on the equipment and responsible for appropriate and safe working practices in its use: - Equipment Lighting JIB Track Radio Mics Other Role Name Signature