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
Production Type
Feature Film
Television Series
Streaming Series
Commercial Advertisement
Music Video
Documentary
Live Broadcast
Other
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 | |
|---|---|---|---|---|---|---|
7/15/2025 | 6:00 AM | 6:30 PM | Scenes 42-45 | High-speed pursuit | 8 | |
7/16/2025 | 7:00 AM | 3:00 PM | Scene 46 | Pyrotechnic explosion | 5 | |
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)
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.
Select All Stunt Categories Applicable to This Permit
Physical Stunts (Falls, Fights, Acrobatics)
Vehicle Stunts (Non-Pyrotechnic)
Pyrotechnics & Explosive FX
High-Speed Driving Sequences
Aerial Stunts (Wire Work, Rappelling)
Water-Based Stunts
Weaponry & Armed Combat
Detailed Stunt Sequence Choreography Description
Upload Complete Storyboard (PDF or Image Sequence)
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 | |
|---|---|---|---|---|---|---|---|---|---|
VEH-001 | Hero Car | 2023 Dodge Charger | XYZ-1234 | Yes | 180 | Roll cage, harness, fire suppression | Mike Chen | ||
VEH-002 | Crash Car | 2015 Sedan (Stripped) | ABC-5678 | Yes | 120 | Remote kill switch, stripped interior | Sarah Park | ||
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 | |
|---|---|---|---|---|---|---|---|---|
FX-001 | Gasoline Fireball | 3 | Class B Flammable | 50 | David Torres | PYRO-2025-447 | 7/15/2025, 2:30 PM | |
FX-002 | Squib Bullet Hits | 12 | Low Explosive | 10 | David Torres | PYRO-2025-447 | 7/15/2025, 10:00 AM | |
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?
Will sequence involve explosions or detonations?
Will sequence involve unmanned aerial vehicles (drones) or manned aircraft?
Specialized Safety Equipment Deployed
Crash Cameras (remote operated)
Wire Rigging Systems
Airbag Landing Systems
Fire Suppression Teams
Bulletproof Barriers
High-Speed Camera Tracking
GPS Tracking on Vehicles
Underwater Safety Divers
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?
Has Local Police Department been formally notified?
Has Emergency Medical Services (EMS) been coordinated?
Has Municipal Film Office or Permitting Authority been notified?
Comprehensive Perimeter Security Plan Description
Security Perimeter Radius from Action Center (meters)
Primary Barrier/Fencing Type
Concrete Jersey Barriers
Water-Filled Barriers
Metal Crowd Control Barriers
Heavy-Duty Chain Link Fencing
Rope/Warning Tape (low-risk only)
Natural Terrain Features
Combination/Hybrid System
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 | |
|---|---|---|---|---|---|---|
James Rodriguez | Perimeter Lead | SEC-8847 | 5/30/2026 | 8 | Channel 7 | |
Lisa Wong | Access Control | SEC-9201 | 8/15/2026 | 5 | Channel 7 | |
Crowd Control Measures Implemented
Physical Barricades
Elevated Observation Posts
Public Address System
Crowd Marshal Team
Aerial Surveillance (Drone)
Helicopter Monitoring
Social Media Monitoring
Local Community Pre-Notification
Expected Maximum Crowd Size (Public/Spectators)
Will public roads be closed or traffic rerouted?
I confirm that official road closure permits have been obtained and are attached to this filing.
Are clearly marked evacuation routes established?
Emergency Assembly Point Location
Primary On-Set Communication Protocol
Digital Radio System (encrypted)
Analog Radio System
Cellular/Satellite Phone Network
Hybrid (Radio + Phone Backup)
Hardwired Intercom
Primary Emergency Contact Number (Direct to Set)
Secondary Emergency Contact Number
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 | |
|---|---|---|---|---|---|---|---|
Alex Rivera | Lead Stunt Double | ISA | ISA-7823 | 1/15/2023 | 1/15/2026 | ||
Jordan Blake | Pyrotechnician | NFA | NFA-PYRO-445 | 6/1/2024 | 6/1/2025 | ||
Upload All Individual Certification Documents (ZIP or PDF)
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 | |
|---|---|---|---|---|---|
General Liability | $5,000,000.00 | 12/31/2025 | Includes stunt rider | ||
Automobile Liability | $2,000,000.00 | 12/31/2025 | Hired/non-owned vehicles | ||
Workers Compensation | $1,000,000.00 | 12/31/2025 | Statutory limits | ||
Upload Complete Insurance Certificate & All Policy Riders
Is dedicated medical standby team present on location?
Medical Team Lead Name & Credentials
Number of Paramedics/EMTs On-Site
Number of Physicians On-Site
Is dedicated ambulance on standby at location?
Nearest Trauma-Capable Hospital Name
Distance to Nearest Hospital (kilometers)
Estimated Emergency Transport Time (minutes)
Medical Equipment Available On-Site
Advanced Life Support (ALS) Kit
Automated External Defibrillator (AED)
Spine Board & C-Collar Set
Portable Oxygen & Ventilator
Burn Treatment Supplies
Hemorrhage Control (Tourniquets/QuikClot)
Blood Pressure & Cardiac Monitor
Field Surgical Kit
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.
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.