Policy PRES-UC-001-QUESTIONNAIRE APPENDIX

Responsible University Administrator:President
Responsible Officer:Office of University Communications
Origination Date:05/14/13
Current Revision Date:N/A
Next Review Date:05/14/17
End of Policy Date:N/A
Policy Number:PRES-UC-001 Questionnaire - Appendix
Status:Effective

 

FILM / PHOTOGRAPHY SHOOT QUESTIONNAIRE

PDF Version

 

QUESTIONNAIRE MUST BE COMPLETED AND SUBMITTED AT LEAST 30 BUSINESS DAYS PRIOR TO REQUESTED DATE OF FILMING.

 

THE COMPLETION OF THIS QUESTIONNAIRE DOES NOT IMPLY OR GIVE APPROVALS FOR THE FILMING/PHOTOGRAPHY.

In order to assist the University in anticipating your film/photography needs, please seek the input of members of each department (production, art, camera, production, grip/electric, and transportation) and have a representative of each review and sign the questionnaire.

 

Date: ________________      Anticipated Shoot Dates:_________________________________

 

Company: _____________________________________________________________________

 

Company Federal ID Number: _________________________

 

Name and Title of Contract Signatory: ______________________________________________

 

Address: ______________________________________________________________________

 

City:_______________________      State:________________  Zip Code: _________________

 

Phone Number(s): ________________________  Facsimile: ____________________________

 

Email: _______________________________________________________________________

 

Website: ______________________________________________________________________

 

Primary contact: ________________________________________________________________

 

Phone: __________________________________  Cell: _______________________________

 

Email: _______________________________________________________________________

 

Alternate Contact: ______________________________________________________________ 

 

Phone: _________________________________   Cell: _________________________________

 

Email:________________________________________________________________________

 

Synopsis of film/shoot:__________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

Story Line: ___________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

A full script may be requested.

 

Will the USM campus be recognizable in the final product?  Yes / No 

 

If yes, please explain in what way the USM campus will be recognizable. __________________

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

Will any USM indicia be used? Yes / No

           

If yes, please explain what USM indicia will be used.  __________________________________

____________________________________________________________________________

____________________________________________________________________________

 

Purpose of the Film/Photographs:  _________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

How is the film/photographs to be distributed?  ______________________________________

____________________________________________________________________________

 

Potential Air or Release Date:  ___________________________________________________

 

Circle Site Location(s) Requested:    Hattiesburg campus      Gulf Coast campus         Both

 

 

Location 1:

Dates(s) at this site:

 

Set up time will begin:

 

Start time of production:

 

Estimated end time of production:

 

Clean up of site will be completed by:

 

Additional Special Needs:

 

 

 

 

Location 2:

Dates(s) at this site:

 

Set up time will begin:

 

Start time of production:

 

Estimated end time of production:

 

Clean up of site will be completed by:

 

Additional Special Needs:

 

 

 

 

Location 3:

Dates(s) at this site:

 

Set up time will begin:

 

Start time of production:

 

Estimated end time of production:

 

Clean up of site will be completed by:

 

Additional Special Needs:

 

 

 

 

Location 4:

Dates(s) at this site:

 

Set up time will begin:

 

Start time of production:

 

Estimated end time of production:

 

Clean up of site will be completed by:

 

Additional Special Needs:

 

 

 

 

Location 5:

Dates(s) at this site:

 

Set up time will begin:

 

Start time of production:

 

Estimated end time of production:

 

Clean up of site will be completed by:

 

Additional Special Needs:

 

 

 

 

Location 6:

Dates(s) at this site:

 

Set up time will begin:

 

Start time of production:

 

Estimated end time of production:

 

Clean up of site will be completed by:

 

Additional Special Needs:

 

 

 

 

Location 7:

Dates(s) at this site:

 

Set up time will begin:

 

Start time of production:

 

Estimated end time of production:

 

Clean up of site will be completed by:

 

Additional Special Needs:

 

 

 

NOTE:  Any additional location sites need to be listed on an attachment. Please notate location needs for the following:  base camp; catering/food services; holding areas for extras; overnight storage of equipment/props; electrical power needs; crew parking; set decorating days pre-shoot; and set striking days post-shoot.

 

Numbers for each day of the shoot:

DATES

NUMBER OF STATIONARY CAMERAS

NUMBER OF HANDHELD CAMERAS

NUMBER OF CREW

NUMBER OF STAFF

NUMBER OF ACTORS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Is there catering? Yes / No

 

Number of Meals each day? ____________

 

Number & Types of Vehicles:  i.e., RV, Van, Limo, Trucks, Box, semis, pickups (please give weights for each vehicle): 

TYPE

OF AUTO

RV

VAN

LIMO

TRUCKS

BOX

SEMIS

PICKUP

CAR

NUMBER

 

 

 

 

 

 

 

 

 

WEIGHT FOR EACH

 

 

 

 

 

 

 

 

 

Parking: Please note that On Campus parking is limited

 

Traffic, noise and lighting impacts will consist of:______________________________________ 

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

Staging including equipment vehicle(s), tents, generators, lighting, storage, etc., will be located:

____________________________________________________________________________

____________________________________________________________________________

____________________________________________________________________________

 

Power sources: _________________________________________________________________

 

Production Provided: Type(s): _____________________________________________________

 

Site power requested: Type(s): ____________________________________________________

 

Will there be any use of Pyrotechnics? Yes / No

 

Will there be any use of firearms/explosives: Yes / No    

 

Are police personnel requested: Yes / No                       

 

Will there be any use of animals: Yes / No      If yes, type:________________________________________________

Will there be any stunts, vehicular or aircraft scenes?  Yes / No 

 

Additional Items that will be necessary:  

  1. Permit,
  2. University’s Film/Photography Location Agreement, insurance certificate,
  3. damage deposit (if required),
  4. check for the full amount of location fee; and
  5. any additional fees for University services requested or required in connection with filming/photography activities.

 

 REVIEWED BY:

 

____________________________________

Production Department Representative

 

 

____________________________________

Art Department Representative

 

 

____________________________________

Camera Department Representative

 

 

____________________________________

Production Sound Department Representative

 

 

___________________________________

Grip / Electric Department Representative

 

 

___________________________________

Transportation Department Representative