Can the questionnaire be signed electronically?

Yes. Electronic signatures are legally recognized under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the signer consents and the record is retained in a reproducible form.

Are medical details protected when stored digitally?

Sensitive health information should be handled under HIPAA when it qualifies as protected health information; use a HIPAA-compliant workflow and a Business Associate Agreement when a covered entity is involved.

Who must sign the form for it to be valid?

The performer must sign and date the questionnaire; a coordinator or witness may also sign when production policy or state law requires additional attestations for releases.

Is notarization ever required?

Notarization is rarely required for routine questionnaires but may be mandated for certain releases or jurisdictional waivers; check local law and production counsel guidance before requiring notarization.

What if a performer’s health changes after signing?

Require immediate notification and an updated questionnaire; document any restrictions or clearances and delay stunt participation until re-evaluation and written approval.

How long must completed questionnaires be kept?

Retention depends on record type: general production files often keep documents for several years, medical records may require six years under HIPAA (45 CFR §164.530(j)), and injury-related records should align with insurer and legal requirements.

Electronic Signature
Templates
Miscellaneous
Stunt Performance Questionnaire

Stunt Performance Questionnaire

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

STUNT PERFORMANCE QUESTIONNAIRE AND AGREEMENT

Producer/Company Name: Production Title:

WHEREAS

WHEREAS, Producer/Company requires specialized stunt performance services in connection with the production identified above; and

WHEREAS, Performer represents that Performer has the training, experience, qualifications and physical condition necessary to perform the specific stunts described in this questionnaire and to comply with all safety directions and protocols established by Producer/Company; and

WHEREAS, the parties desire to record the Performer's qualifications, medical fitness, insurance information and certain contractual terms governing the engagement.

1. PERFORMER INFORMATION

Performer Name

Date of Birth:

SSN (last 4 digits):

Address

Phone:

Email:

Agent/Manager:

2. EMERGENCY CONTACT

Contact Name

Relationship:

Phone:

3. ENGAGEMENT DETAILS & SCOPE OF WORK

Stunt Sequence(s) Proposed

Anticipated Start Date:

Anticipated End Date:

4. QUALIFICATIONS, TRAINING AND EXPERIENCE

Years of Stunt Experience Primary Disciplines (check all that apply)

High fall Wirework/rigging Fight choreography Precision driving Fire stunt Water rescue/diving Motorcycle

Certifications, Licenses and Schools Attended

5. MEDICAL HISTORY & FITNESS

Do you have any of the following conditions? (check all that apply)

Heart condition Asthma Epilepsy/seizures Recent surgery Other condition

Current Medications or Allergies Primary Care Physician

6. INJURY, CLAIMS AND AVAILABILITY

Prior Injuries or Workers' Compensation Claims (last 10 years) Current Availability Restrictions

7. INSURANCE

Do you carry personal liability or accident insurance? Yes No

Insurer Name / Policy Number / Expiration

Producer/Company provided medical/accident coverage confirmed: Yes No

8. SAFETY, EQUIPMENT AND REHEARSALS

Required Safety Equipment Rehearsal Requirements

9. REPRESENTATIONS, WARRANTIES AND ACKNOWLEDGMENTS

Performer represents and warrants that all information provided in this questionnaire is true, complete and correct to the best of Performer's knowledge; that Performer is physically and mentally fit to perform the described stunts; and that Performer will comply with all safety rules, instructions of the stunt coordinator, and applicable laws and regulations.

Performer expressly acknowledges the inherent risks associated with stunt performance and agrees to follow all safety procedures and to submit to any required medical examination prior to performing any stunt. Performer authorizes Producer/Company to obtain emergency medical treatment in the event Performer is unable to consent.

Performer Certification

I certify that the information in this questionnaire is accurate and complete, and I acknowledge that falsification or omission of relevant medical or training information may be grounds for removal from the production and for withholding of payments.

I certify the foregoing.

10. PAYMENT TERMS

Compensation Amount: Payment Schedule:

Late Payment Fee:

11. TERM AND TERMINATION

Term Start Date: Term End Date:

Either party may terminate this engagement for material breach or for convenience by providing written notice to the other party. Notice Period (days):

12. CONFIDENTIALITY

Performer shall keep confidential all non-public information regarding the production, its content, proprietary techniques, safety protocols and personnel. Confidential information shall not be disclosed to third parties except as required by law or with prior written consent of Producer/Company. This obligation survives termination of the engagement for a period of two (2) years.

Performer acknowledges and agrees to the confidentiality provision above.

13. GOVERNING LAW; ENTIRE AGREEMENT

Governing Law: The parties agree that this Questionnaire and any resulting engagement shall be governed by the laws of the state of without regard to conflict of law principles.

Entire Agreement: This document, together with any attachments or referenced rider signed by both parties, constitutes the entire agreement between the parties with respect to the subject matter herein and supersedes all prior oral and written communications. Any modification must be in writing and signed by both parties.

14. RELEASES, AUTHORIZATIONS AND CONSENTS

By signing below, Performer authorizes Producer/Company to obtain emergency medical treatment if Performer is incapacitated, confirms permission for use of recorded performances as agreed in the separate performer agreement, and acknowledges that Performer will comply with the instructions of the stunt coordinator and safety personnel.

I acknowledge and consent to the authorizations above.

Performer Printed Name:

By:

Date:

Producer/Company Printed Name:

By:

Date:

What the Stunt Performance Questionnaire Is

A Stunt Performance Questionnaire is a standardized form used by production companies, safety officers, and coordinators to collect a performer’s medical history, training, experience, equipment needs, and emergency information before engaging in stunt work. It documents physical limitations, recent injuries, required medical clearances, insurance details, and prior stunt credits to assess suitability for specific sequences and to support risk management and regulatory compliance on set.

Why a Formal Stunt Questionnaire Matters

A completed questionnaire reduces ambiguity about a performer’s readiness, supports informed assignment decisions, and creates a written record for production safety reviews and insurance claims. It also helps coordinate medical clearances and specialized rigging or equipment needs while preserving evidence of informed consent and acknowledgement of hazards.

Typical Users and Signers

Completed forms stay with the production safety file and are shared with relevant stakeholders according to privacy rules.

Production Safety Officers checking competence and equipment needs prior to stunts.
Stunt Coordinators documenting prior experience, specialty skills, and training certificates.
Performers providing medical disclosures, emergency contacts, and insurance details before call time.

Representative Roles Who Complete or Review the Form

Production Safety

Production safety officers use the questionnaire to triage risks, assign medical clearances, and coordinate PPE, rigging, and on-site medical coverage. They rely on documented training and medical items to approve or restrict specific stunt actions.

Performer

The performer supplies accurate medical history, recent injuries, certifications, and emergency contact data; their responses determine eligibility for assigned stunts and inform any required medical or insurance conditions prior to participation.

Core Sections to Include in a Professional Questionnaire

A complete questionnaire groups information for rapid review by safety teams, medical staff, and coordinators. The following six elements form the practical anatomy of the document.

Performer ID

Full legal name, stage name, date of birth, contact details, and government ID reference to verify identity and match personnel records during safety briefings and insurance checks.

Medical Background

Current medical conditions, medications, recent surgeries, allergy information, and a record of physical limitations or rehabilitative restrictions relevant to stunt activity and emergency planning.

Training & Certifications

List of stunt specialties, formal certifications, recent safety courses, and instructor names with dates to verify competency for high-risk tasks and specialist rigging or fight choreography.

Experience & Credits

Summary of prior stunt credits, years of experience, notable sequences performed, and references to previous coordinators to support role matching and liability assessment.

Equipment & PPE

Declared personal equipment, required production-supplied gear, helmet and harness sizes, and notes on custom protective modifications needed for specific sequences.

Insurance & Releases

Primary insurance carrier, policy number, producer release acknowledgement, emergency medical consent, and any notarization or witness requirements mandated by production or jurisdiction.

Step-by-Step: Completing and Submitting the Questionnaire

Follow these steps to provide complete information and route the form to safety and production teams for review.

01

Receive Form: Open the questionnaire sent by production or access it via the secure platform.
02

Complete Fields: Fill required fields, attach medical certificates, and list training records.
03

Review with Coordinator: If requested, review answers with the stunt coordinator for clarity.
04

Sign and Submit: Electronically sign and submit to the production safety officer for approval.

Configuring the Questionnaire for Online Use

Recommended digital settings streamline review, enforce required fields, and reduce manual follow-up during production.

Field	Configuration
Signature Field	Required and time-stamped
Conditional Fields	Reveal medical follow-up when flagged
Authentication	Email plus optional SMS code
Attachments	Allow PDF, JPG, PNG uploads

Where Completed Questionnaires Go

A clear routing path ensures the right team receives the information for approval, clearance, and recordkeeping.

Production Safety: Primary reviewer for clearances and risk mitigation
Stunt Coordinator: Checks suitability for planned sequences
Insurance Provider: Receives copies when requested for claims or verification
Personnel File: Stored with HR or production records for retention

Digital Signing and File Format Considerations

Choose a provider that supports audit trails, exportable signed PDFs, and integration with your production or HR systems for seamless recordkeeping and retrieval.

File Types: PDF, DOCX accepted
Authentication: Email or SMS code
Integrations: CRM and cloud storage

Typical Timelines and Deadlines

Set clear submission windows and medical deadlines to prevent last-minute safety gaps and scheduling conflicts.

Pre-Production Submission:

Submit completed questionnaire at least 72 hours before first rehearsal or stunt call.

Medical Clearance Window:

Obtain required physician clearance within 30 days of the scheduled stunt.

Annual Updates:

Refresh medical and certification information at least once per 12 months.

Change Notification:

Report new injuries or health changes within 48 hours of occurrence.

On-Set Verification:

Coordinator verifies signatures and attachments before first stunt run.

Common Preparation Errors to Avoid

Incomplete medical histories that omit recent surgeries or rehab timelines, causing unsafe role assignments and delayed approvals.
Missing or expired certification documents that require coordinator follow-up and can remove performers from sequences.
Using only informal email confirmations instead of a signed questionnaire, leaving gaps in documented consent and risk acknowledgement.
Uploading illegible photos of certificates or documentation instead of clear PDFs, which increases verification time and administrative friction.

Risks and Consequences of Inaccurate or Missing Information

Insurance Denial: Claims may be denied

Increased Liability: Producer faces higher risk

Work Removal: Performer may be restricted

Regulatory Exposure: OSHA or state probe risk

Medical Harm: Inadequate response to emergencies

Contractual Breach: Release terms may be contested

Essential Fields and Sensitive Data Considerations

Medical History: Protected health data

Emergency Contact: Personal contact details

Training Records: Certifications and dates

Insurance Info: Carrier and policy number

Signature Block: Signed and dated entry

Attachments: PDF or image files

eSignature Provider Comparison for Stunt Questionnaires

Compare basic vendor pricing and capability indicators relevant to signing and storing medical or safety questionnaires for production use.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Practical Use Cases from Production Workflows

Realistic scenarios illustrate how the questionnaire supports safety, casting, and insurance workflows across different production scales.

Case: Film Unit

A midsize film unit collected questionnaires before stunt rehearsals

Coordinator flagged a knee surgery history
The team adjusted choreography, obtained medical clearance, and documented the accommodation for insurance and safety reviews.

Case: Independent Coordinator

An independent coordinator required certificates for wirework and high falls

One performer lacked recent training proof
The coordinator scheduled a refresher and recorded the temporary restriction, preventing unsafe assignment and preserving liability records.

Frequently Asked Questions About Using the Questionnaire

Answers to common procedural and legal questions about completion, protection of medical data, signatures, and recordkeeping.

Need help? Contact support

Can the questionnaire be signed electronically?
Yes. Electronic signatures are legally recognized under the ESIGN Act (15 U.S.C. ch. 96) and UETA in most states, provided the signer consents and the record is retained in a reproducible form.
Are medical details protected when stored digitally?
Sensitive health information should be handled under HIPAA when it qualifies as protected health information; use a HIPAA-compliant workflow and a Business Associate Agreement when a covered entity is involved.
Who must sign the form for it to be valid?
The performer must sign and date the questionnaire; a coordinator or witness may also sign when production policy or state law requires additional attestations for releases.
Is notarization ever required?
Notarization is rarely required for routine questionnaires but may be mandated for certain releases or jurisdictional waivers; check local law and production counsel guidance before requiring notarization.
What if a performer’s health changes after signing?
Require immediate notification and an updated questionnaire; document any restrictions or clearances and delay stunt participation until re-evaluation and written approval.
How long must completed questionnaires be kept?
Retention depends on record type: general production files often keep documents for several years, medical records may require six years under HIPAA (45 CFR §164.530(j)), and injury-related records should align with insurer and legal requirements.

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