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Rooftops, Fire Escapes, Balconies & Bridges
Students: Read and Complete This Entire Form
GENERAL INSTRUCTIONS:
Use the TAB key or MOUSE click to move from field to field.
CAUTION: Using the ENTER key will automatically submit the form.

PLEASE REVIEW YOUR SUBMISSION BEFORE CLICKING "SUBMIT"
Distribution of Certificates
This is a SPECIAL INSURANCE REQUEST, it may take an additional one to two weeks to process your insurance, so start early.
PLAN ACCORDINGLY!!
GENERAL PRODUCTION INFORMATION

Have you submitted the "Production Registration Form"?:
Yes  No

If you answered "No" this will redirect you to the proper Production Registration Form.

Original Name of Production:

Director's Name (No nicknames. List name as registered with NYU!):
First Name:
Last Name:
Insurance Contact - Email Address:
Email address must be an NYU issued email.
Must end in @nyu.edu. All others will be rejected, and your form will have to be resubmitted.

Give a full description of the scenes shot on a Roof top, Fire Escape, Balcony, Bridge, etc.:


Where is the Roof top, Fire Escape, Balcony, Bridge Location?:


FOR BRIDGES ONLY

What type of scene is this?:
Bridge Over Land Bridge Over Water

How tall is the Bridge?:

Provide a complete description of what is below the Bridge:


Have you Received Permission From The Building and/or Location Manager/Owner For This Shoot?:
Yes No

Manager/Owner Name:
Manager/Owner Contact Phone Number:

Has the the Manager/Owner confirmed that the roof or
structure is capable of supporting what you plan to do?: Yes No

How Many Stories is the Building?:

How Many Days will your Shoot take place on this Roof or Structure?:

How Many Hours per Day (average) will the Cast and Crew be on the Roof?:

Is there a Wall or Fence at the Roof or Balcony Edge?: Yes No

If Yes, Please give details on Wall or Fence:

How close to the edge will Cast and Crew be located?:
(Please Describe in Detail!)


What Precautions are being taken to Protect &
Secure the Equipment & Persons on the Roof?:


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