Science Safety Agreement
- Follow all written and oral instructions given by the teacher.
- Ask questions, or state concerns before beginning a lab procedure.
- Behave in a manner that will ensure the health and safety of myself and
others in the laboratory or classroom at all times.
- Use protective devices for my eyes, face, hands, body and clothing during
- Know the location and use of first aid and fire extinguishing equipment.
- Refrain from eating, drinking, chewing gum or applying cosmetics in the
- Keep my work area clean and free of clutter during lab class.
I understand and realize that many accidents are caused by carelessness and being
in a hurry. I will come to class prepared to be responsible so that the safety and
welfare of myself and others is not jeopardized.
I have read the set of written science safety rules prepared by my teacher and agree
to follow these and any other rules.
|Date _________________ || Student___________________________________|
|Date _________________ || Parent/Guardian____________________________|
In case of accident or emergency contact:
|Name:_____________________________ || Phone #______________________|
|Name:_____________________________ ||Phone #______________________|
Please list any known allergies or health problems: (If additional space is needed,
please use the back of this sheet.): ______________________________________
Contact lenses should not be worn in the laboratory as certain chemical fumes or
small particulate may become lodged under the lens. Please be aware of the slight
increase in the risk of eye damage for contact wearers as compared to students in
similar situations without contact lenses. All students are required to wear goggles
during procedures which involve the use of chemicals, dissection or projectiles.
I__________________________ (Parent/Guardian) have read the above and will give my
permission for, ____________________ (student) to wear contact lenses (with goggles)
in science lab.
Parent and Student Responsibilities
Students must know and follow the science safety rules and sing the science safety
agreement before participating in any science labs. Parents must read and sign the
science safety agreement acknowledging the need for their child to follow the safety
rules and procedures as set out by the contract.
Both parents and students acknowledge that if the student and/or parent refuses to
sign the science safety agreement or the student subsequently repeatedly refuses
to follow the science safety rules and procedures, the student will be banned from
participation in the science labs. The parents and students acknowledge that lack of participation
in the assigned science labs will reduce the student's grade as determined by the