Authorization Permit: High-Risk Filming Operations

1. Production Title, Shoot Location Coordinates & Schedule Metadata

Provide complete production identification and logistical metadata. All location coordinates must be verified via GPS and cross-referenced with municipal mapping systems. Schedule details must reflect actual crew call times and estimated wrap times to ensure emergency services coordination.

Production Title

Production Company Legal Entity

Primary Shoot Location Name

Full Physical Address & Landmark References

GPS Coordinates (Decimal Degrees)

Shoot Schedule & Scene Breakdown

	Shoot Date	Crew Call Time	Estimated Wrap Time	Scene Numbers	Stunt Type per Scene	Estimated Takes
	A	B	C	D	E	F
1	7/15/2025	6:00 AM	6:30 PM	Scenes 42-45	High-speed pursuit	8
2	7/16/2025	7:00 AM	3:00 PM	Scene 46	Pyrotechnic explosion	5
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Total Estimated Duration (Hours)

Safety Meeting Date/Time

Key On-Set Contact Person

Key Contact Direct Phone

Key Contact Email

Weather Contingency Date

Alternative Indoor/Controlled Location (if applicable)

2. Stunt Sequence Choreography, Vehicle Specs & FX Hazard Analysis

Provide exhaustive technical specifications for all stunt sequences. Include frame-by-frame choreography notes, vehicle engineering data, and comprehensive hazard analysis for special effects. Upload all pre-visualization materials and engineering certifications.

Physical Stunts Section: Complete detailed performer choreography, fall heights, impact surfaces, and wire rig specifications in the fields below.

Vehicle Stunts Section: Provide non-explosive vehicle specifications including ramp angles, jump distances, and rollover protections.

Pyrotechnics Section: Complete the dedicated pyrotechnics hazard analysis table and upload all explosive storage permits.

High-Speed Section: Specify maximum speeds, road surface conditions, and traffic control measures for velocities exceeding 50 km/h (31 mph).

Detailed Stunt Sequence Choreography Description

Upload Complete Storyboard (PDF or Image Sequence)

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Total Number of Performers & Drivers Involved

Vehicle Specifications & Safety Verification

	Vehicle ID Code	Vehicle Type/Category	Make, Model & Year	License Plate/VIN	Modified for Stunts?	Max Speed Capability (km/h)	Primary Safety Equipment	Stunt Driver Name	Insurance Verified
	A	B	C	D	E	F	G	H	I
1	VEH-001	Hero Car	2023 Dodge Charger	XYZ-1234	Yes	180	Roll cage, harness, fire suppression	Mike Chen
2	VEH-002	Crash Car	2015 Sedan (Stripped)	ABC-5678	Yes	120	Remote kill switch, stripped interior	Sarah Park
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Pyrotechnics & Special Effects Inventory

	FX ID Code	Effect Type/Description	Total Quantity	Hazard Classification	Required Safety Distance (meters)	Licensed Pyrotechnician	Permit/Authorization Number	Planned Detonation Time
	A	B	C	D	E	F	G	H
1	FX-001	Gasoline Fireball	3	Class B Flammable	50	David Torres	PYRO-2025-447	7/15/2025, 2:30 PM
2	FX-002	Squib Bullet Hits	12	Low Explosive	10	David Torres	PYRO-2025-447	7/15/2025, 10:00 AM
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Hazard Analysis Matrix: Rate Each Risk Factor

	Very Low	Low	Medium	High	Very High
Performer Injury Risk (falls, impacts, collisions)
Crew & Bystander Injury Risk
Public Safety Risk (uncontrolled area)
Property Damage Risk (structures, vehicles)
Environmental Impact (fire, water contamination)
Equipment Failure Risk (mechanical, electrical)

Exclusion Zone Radius from Epicenter (meters)

Safety Buffer Zone Radius (meters)

Will sequence involve open flames or fire effects?

Yes

No

Specify fire type, fuel source, containment measures, and fire watch protocol:

Will sequence involve explosions or detonations?

Yes

No

Specify explosive type, blast radius calculations, structural shrapnel assessment, and secondary containment:

Will sequence involve unmanned aerial vehicles (drones) or manned aircraft?

Yes

No

Specify aircraft type, flight path, altitude, remote pilot certification, and airspace clearance:

3. Municipal Emergency Services (Fire/Police) Coordination & Perimeter Security Plan

Document all coordination with municipal authorities and comprehensive perimeter security measures. Provide direct liaison officer contacts, security personnel deployment plans, and verified evacuation protocols. Failure to coordinate adequately will result in automatic permit denial.

Has Local Fire Department been formally notified?

Yes

No

Provide Fire Department Liaison Details: Officer Name, Rank, Direct Phone, Notification Date, Station Number:

WARNING: Fire Department notification is mandatory. Submit proof of notification before permit can be approved.

Has Local Police Department been formally notified?

Yes

No

Provide Police Department Liaison Details: Officer Name, Rank, Direct Phone, Notification Date, Precinct:

Has Emergency Medical Services (EMS) been coordinated?

Yes

No

Provide EMS Liaison Details: Supervisor Name, Station Location, Direct Phone, Estimated Response Time:

Has Municipal Film Office or Permitting Authority been notified?

Yes

No

Provide Film Office Contact: Officer Name, Permit Number, Special Conditions Imposed:

Comprehensive Perimeter Security Plan Description

Security Perimeter Radius from Action Center (meters)

Total Number of Security Personnel Deployed

Security Personnel Assignment & Credentials

	Security Officer Name	Assigned Role/Position	Certification/License Number	Certification Expiry	Years Experience	Direct Radio Channel
	A	B	C	D	E	F
1	James Rodriguez	Perimeter Lead	SEC-8847	5/30/2026	8	Channel 7
2	Lisa Wong	Access Control	SEC-9201	8/15/2026	5	Channel 7
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Expected Maximum Crowd Size (Public/Spectators)

Will public roads be closed or traffic rerouted?

Yes

No

Provide Road Closure Details: Affected Streets, Closure Times, Detour Routes, Public Notification Method, Traffic Control Personnel Count:

I confirm that official road closure permits have been obtained and are attached to this filing.

Are clearly marked evacuation routes established?

Yes

No

Describe primary and secondary evacuation routes, assembly points, and headcount procedures:

Emergency Assembly Point Location

Primary Emergency Contact Number (Direct to Set)

Secondary Emergency Contact Number

4. Stunt Personnel Certifications, Special Insurance & Medical Standby Audit

Verify all personnel credentials, insurance coverage limits, and medical standby capabilities. Upload scanned certification documents and insurance certificates. Incomplete documentation will suspend permit approval until rectified.

Stunt Coordinator Full Legal Name

Stunt Coordinator Certification Number

Certifying Body/Association

Stunt Coordinator Certification Expiry Date

Stunt Coordinator Years of Professional Experience

All Stunt & FX Personnel Certification Log

	Full Name	Role/Position	Certifying Body	Certification Number	Issue Date	Expiry Date	Valid & Verified
	A	B	C	D	E	F	G
1	Alex Rivera	Lead Stunt Double	ISA	ISA-7823	1/15/2023	1/15/2026
2	Jordan Blake	Pyrotechnician	NFA	NFA-PYRO-445	6/1/2024	6/1/2025
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Upload All Individual Certification Documents (ZIP or PDF)

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Special Effects Supervisor License Number

Production Insurance Policy Number

Insurance Provider Name

Insurance Coverage Verification

	Coverage Type	Coverage Limit	Policy Expiry	Certificate Received	Policy Rider Notes
	A	B	C	D	E
1	General Liability	$5,000,000.00	12/31/2025		Includes stunt rider
2	Automobile Liability	$2,000,000.00	12/31/2025		Hired/non-owned vehicles
3	Workers Compensation	$1,000,000.00	12/31/2025		Statutory limits
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Upload Complete Insurance Certificate & All Policy Riders

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Is dedicated medical standby team present on location?

Yes

No

Detail medical team composition: Lead physician/paramedic, number of EMTs, ambulance availability, field hospital setup:

CRITICAL: Medical standby is mandatory for all high-risk stunt operations. Permit cannot be approved without on-site medical capability.

Medical Team Lead Name & Credentials

Number of Paramedics/EMTs On-Site

Number of Physicians On-Site

Is dedicated ambulance on standby at location?

Yes

No

Nearest Trauma-Capable Hospital Name

Distance to Nearest Hospital (kilometers)

Estimated Emergency Transport Time (minutes)

Personnel Competency Verification (Rate 1-5)


Stunt Coordinator - Overall Sequence Planning
Lead Stunt Performer - Execution Proficiency
Support Performers - Role Preparedness
Special Effects Supervisor - Hazard Control
Production Safety Supervisor - Risk Oversight

I confirm that all personnel possess current, valid certifications for the specific stunt activities listed in this permit.

5. Production Safety Supervisor & Lead Executive Producer Joint Sign-Off

Final authorization requires joint sign-off from both Production Safety Supervisor and Lead Executive Producer. By signing, both parties attest that all information is accurate, all safety measures are in place, and all regulatory notifications have been completed. This permit is valid only for the specific date(s), location(s), and stunt sequences described herein. Any deviations require immediate permit amendment and re-approval.

Production Safety Supervisor Full Legal Name

Production Safety Supervisor License/Certification Number

I, as Production Safety Supervisor, have personally reviewed all stunt choreography, hazard analyses, personnel certifications, and security plans. I attest that all protocols meet or exceed industry safety standards and that all municipal coordination has been verified.

Production Safety Supervisor Digital Signature

Safety Supervisor Sign-Off Timestamp

Lead Executive Producer Full Legal Name

Lead Executive Producer Title

I, as Lead Executive Producer, accept full financial and legal responsibility for this production. I authorize the stunt sequences as described and certify that all insurance coverage is active and adequate. I understand that any misrepresentation may result in immediate permit revocation and production shutdown.

Lead Executive Producer Digital Signature

Executive Producer Sign-Off Timestamp

Final Risk Acceptance Level (As Determined by Safety Supervisor)

Low Risk - Standard precautions adequate

Medium Risk - Enhanced monitoring required

High Risk - Dedicated safety officers mandatory

Extreme Risk - Continuous executive oversight required

Additional Conditions, Notes or Special Provisions

I acknowledge that this permit is subject to on-site inspection by safety officers and emergency services liaisons. Failure to comply with stated safety measures will result in immediate cessation of filming activities.