STUDENT SAFETY AGREEMENT

I will:

  1. Follow all instructions given by the instructor.
  2. Protect eyes, face, hands and body during laboratory activities.
  3. Carry out good housekeeping practices.
  4. Know where to get help fast.
  5. Know the location and use of first-aid and fire-fighting equipment.
  6. Conduct myself in a responsible and thoughtful manner at all times in the laboratory.

This is to certify that I, ___________________________________ (print student’s name) have received safety instructions in my Chemistry class and that I have read and agree to follow all of the safety rules set forth in the Safety Rules and Guidelines.  I realize that I must obey these rules to insure my own safety, and that of my fellow students and instructors.  I will cooperate to the fullest extent with my teacher and fellow students to maintain a safe lab environment.  I will also closely follow the oral and written instructions provided by the instructor.  I am aware that any violation of this safety agreement that results in unsafe conduct in the laboratory or misbehavior on my part, may result in being removed from the laboratory, detention and/or dismissal from the course.

(student signature)_________________________________                        (date) ____________

QUESTIONS FOR STUDENT

Do you wear contact lenses?  __ YES    ___ NO           

 

Are you color blind?  ___ YES   ___ NO

 

Dear Parent or Guardian:

I feel that you should be informed regarding the school’s effort to create and maintain a safe chemistry laboratory environment.  With the cooperation of the instructors, parents, and students, a safety instruction program can eliminate, prevent and correct possible hazards.

You should be aware of the safety instructions your student will receive before engaging in any laboratory work.  Please read the list of safety rules and guidelines attached.  No student will be permitted to perform laboratory activities unless this agreement is signed by both the student and parent/guardian and is on file with the teacher.

Your signature on this contract indicates that you have read this Safety Rules and Guidelines, are aware of the measures taken to insure the safety of your student in the science laboratory, and will instruct your child to uphold his/her agreement to follow these rules and procedures in the laboratory.

 

(parent signature)_________________________________                        (date)_____________