SAG-AFTRA SIGNATORY APPLICATION

SCREEN ACTORS GUILD-AMERICAN FEDERATION OF TELEVISION AND RADIO ARTISTS
SIGNATORY APPLICATION

Submit this form at least 3 weeks before the first travel, rehearsal or shoot date (whichever is earliest)
Form_ID
Your Information
Name *

First Name Last Name
Email *
example@example.com
Phone
Please enter a valid phone number.

SIGNATORY INFORMATION
Company Structure *

Individual Corporation LLC Partnership Other
Signatory Name *

First Name Last Name
Signatory Company *
Please enter the company name exactly it appears on your supporting documents.
Email *
example@example.com
Phone *
Please enter a valid phone number.
Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Federal ID# *
Company State of Formation *
Signatory Documents *

Please attach all company formation documents or government issued ID.
Cancel of

PROJECT FINANCES
Total Budget *
Is the budget per episode? *

Yes No
Are you deferring payment to Performers? *

Yes No
Performer Budget *
Please include deferred payments for New Media, Student, or SPA agreements.
Background Actor Budget
Payroll House (Principals): *
Contact *
Phone *
Payroll House (Background)
Contact
Phone
Bank Name
Branch
Staff Referral
Line-Item Budget *

Cancel of

FILM SCHOOL DETAILS
Is this project a class requirement for a Film School? *

Yes No
Name of the Film School *
Professor's Name *

First Name Last Name
Professor's Email *
example@example.com

INSURANCE CARRIERS
Workers’ Compensation *
Airline (as applicable)
Public Liability/Disability
Errors and Omissions

OWNERSHIP
Current Owner(s) of Picture *
Future Owner(s) of Picture *
Current security interest, lien holder(s) *
Future security interest, lien holder(s) *
Chain-of-Title Docs *

Please attach all Chain-of-Title documents, including those recorded and not recorded with the United States Copyright Office (USCO), and Proof of USCO Registration - Form PA, proof of payment & mailing OR Form eCO, two emails from the USCO confirming upload and payment.
Cancel of

PRE-PRODUCTION CAST LIST
How will you provide the cast list for your project? *

I will enter my known cast into this online form. I will upload a Pre-Production document here.
Cast List (include all known roles and only enter the performer names and enter performer names and IDs as "TBD" for all roles not yet cast.) *
Cast List *

Cancel of
You can download our template Pre-Production Cast List here.

CERTIFICATION BY AUTHORIZED REPRESENTATIVE
The undersigned, by signing below, certifies, represents and warrants that: (a) s/he has the requisite power and authority to sign this document on behalf of the Signatory Company; (b) s/he reviewed the foregoing information; and (c) such information is complete, true and accurate to the best of her/his knowledge. Further, the undersigned acknowledges and agrees any omission, misrepresentation or false statement of fact knowingly made herein and material to the financial assurances delivered by the Signatory Company to SAG-AFTRA will constitute a default under the Theatrical Adherence Letter applicable to this project. A scanned or electronic signature has the same force and effect as an original signature.
Signatory Company *
Printed Name *
Title *
e.g. "Line-Producer", "Producer", etc.
Signature *

Clear
Date

Month Day Year
Date Submitted

HEALTH AND SAFETY QUESTIONNAIRE
Dear Producer,

Production must comply with both CDC and OSHA workplace requirements, Federal, State, County, and City guidelines regarding hazards in the workplace for COVID-19, along with the Return to Work Agreement effective as of September 21, 2020 (as applicably modified by The Safe Way Forward).

Producer must review the Return to Work Agreement (dated as of September 21, 2020) and The Safe Way Forward, provided on the SAG-AFTRA website, to inform its responses below.

PLEASE REVIEW THE DOCUMENTS LINKED BELOW:

Return to Work Agreement

The Joint Unions Document – “The Safe Way Forward”

COVID-19 Safety Protocols: Singers

SAG-AFTRA Resources and Downloads

COVID-19 Compliance Supervisor ("CCS")

Also referred to as a Covid-19 Compliance Officer and Health Safety Supervisor
CCS Name *

First Name Last Name
CCS Email
example@example.com
CCS Phone
Please enter a valid phone number.
CCS Resume

Cancel of
The CCS is only employed in this role *

Yes No, the CCS also has other roles on set (e.g. onset medic, nurse, etc.)
CCS's other roles *
Does the CCS have medical or acute care training? *

Yes No
If No, will the CCS be supported by an on set medic? *

Yes No
Does the CCS have training certification in CDC and OSHA COVID-19 protocols? *

Yes No

Cast & Crew Training
Cast & Crew Training (select all that apply) *

CCS will conduct training on COVID-19 protocols and procedures with cast and crew prior to the first day of principal photography. Regular and frequent safety meetings will be scheduled to reinforce COVID-19 protocols. Explanation, instruction, and diligent adherence to the Zone System. Training and floor markers to reinforce physical distancing (especially in video village and catering areas), entrances, exits, with choke points addressed.

Testing Frequency
Zone Testing: Confirm that you are conducting all of the following testing *

3x a week in Zone A 1x a week in Zone B 1x every other week in Zone C Pre-employment testing in Zone D
Pre-Travel Testing *

Pre-travel testing, if any cast or crew is traveling for production Not applicable, no travel
Failing to check and acknowledge all of the above could result in a delay in safety clearing the project.

COVID-19 Testing Details
Type of Testing *

In-lab real time Polymerase Chain Reaction (PCR) Testing Rapid Testing (may not be antigen or antibody tests) Other
Name and CLIA number of lab analyzing specimen *
Name of Rapid Test *
If you are using more than one type of testing, please describe the schedule of when each will be used
Method of Collection *

Nasopharyngeal Testing Anterior Nasal Testing Oropharyngeal Testing Saliva Testing Other

Physically Engaging Scenes
Confirm Testing for Physically Engaging Scenes *

By checking here, you understand that any scenes requiring close/intimate contact and/or extreme exertion may require daily testing of cast and crew involved in the production of these scenes.
Will there be singing in any scenes? *

Yes No
If Yes, confirm that you will adhere to SAG-AFTRA Singing Protocols. *

Yes No
Will there be dancing in any scenes? *

Yes No
If Yes, confirm that you will adhere to SAG-AFTRA Dancing Protocols. *

Yes No

Travel and Transportation
Confirm Pre-Flight Testing *

By checking here, you understand that any cast and crew traveling by air must be pre-flight tested within 48 hours of flight.
Select the applicable form of transportation to your production *

Principal performers and Background Actors will be transported to and from set by production vehicles. Principal performers and Background Actors will drive their own vehicles to and from set and production will provide or reimburse for parking. Other (please specify)
Company Moves *

By checking here, you are confirming production is not planning any company moves of more than one location on the same day. By checking here, you are confirming production is planning to have company moves of more than one location on the same day.
Please list all company move days and how many locations for each *

Ventilation
Confirm Ventilation *

By checking here, you are confirming production will provide proper ventilation in all interiors as defined by Air Exchanges per Hour (ACH), Percentage of Outside Air (OA), and the Filter Grade (MERV) of the HVAC System.

The ACH minimum is six (6) in all variations shown in the chart below which corresponds the OA necessary to the MERV Filter Grade.

MERV FILTER GRADE #	MINIMUM OUTDOOR AIR (OA)
17	20%
16	25%
15	30%
14	35%
13	40%
Any #	100%

Additional HEPA

If these standards cannot be achieved by the HVAC system, additional HEPA filtration units can be used. By checking here, you are confirming that HEPA units will be supplementing your ventilation plans and you have measured accordingly the capacity and/or amount of units to satisfactorily address ventilation in all interiors (as per above standards).
For all interiors for which HEPA units are proposed, the following must be calculated:
1. Make and model number of the HEPA unit or units,
2. CFM (cubic feet per minute),
3. Recommended square footage from label or manual,
4. Square footage of room, and
5. Ceiling height

Set Visits

Please provide the name and contact information for the production representative with whom SAG-AFTRA can coordinate set visits by SAG-AFTRA representatives.
Production Representative Name *

First Name Last Name
Production Representative Email *
example@example.com
Production Representative Phone *
Please enter a valid phone number.

Certification
By signing below, you certify that that all information set forth and all representations and agreements made herein are true and correct. If you are signing on behalf of a company, you further certify that you are empowered and authorized to make these representations on the company’s behalf.

Producer Agreed and Accepted:
Signature *

Clear
Date *

Month Day Year
Date
Name *

First Name Last Name
Title *
Should be Empty:

SCREEN ACTORS GUILD-AMERICAN FEDERATION OF TELEVISION AND RADIO ARTISTS

SIGNATORY APPLICATION

Your Information

PROJECT INFORMATION

SIGNATORY INFORMATION

PROJECT FINANCES

PRODUCTION DETAILS

FILM SCHOOL DETAILS

INSURANCE CARRIERS

OWNERSHIP

FINANCIERS

DISTRIBUTORS & SALES AGENTS

PRE-PRODUCTION CAST LIST

CERTIFICATION BY AUTHORIZED REPRESENTATIVE

HEALTH AND SAFETY QUESTIONNAIRE

COVID-19 Compliance Supervisor ("CCS")

Cast & Crew Training

Testing Frequency

COVID-19 Testing Details

Physically Engaging Scenes

Travel and Transportation

Ventilation

Set Visits

Certification