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Open Flames, Camp Fires, Fires, etc.
Students: Read and Complete This Entire Form
GENERAL INSTRUCTIONS:
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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.

Location(s) of Open Flames, Camp Fires, Fires, etc.:


Please Give A Detailed Description Of Your Shoot:


Please Describe, In Complete Detail, The Type of Fire Exposure:


Describe Safety Precautions Being Exercised:

Note: Portable Fire Extinguishers Must be on hand at all times during a shoot involving any type of Fire.

How far will the shoot be to the nearest Fire Hydrant?:

How far is the shoot location to the nearest Fire House?:

Will the Local Fire House be notified of the Fire Exposure?: Yes No

Are special permits required by local authorities?: Yes No

If Yes, have these permits been obtained?: Yes No

Permit #: Authority issuing Permit:

Will Protective Clothing be worn by Cast & Crew members?: Yes No

Has a designated "Safe Area" been assigned?: Yes No


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