(Please READ, COMPLETE, and KEEP in your book)
I, ______________________________________________ (print your name), recognize that the laboratory is a safe place to work and learn only if I conduct myself in a responsible manner.† I agree to assume responsibility for my own safety and for the safety of my classmates.† I agree to follow the laboratory expectations and agree to follow the teacherís directions to the best of my ability.† Specifically:
* I will learn and follow the Behavior Expectations.
* I will learn and follow the Laboratory Expectations.
* I will handle laboratory equipment properly and safely.
* I will familiarize myself with the techniques in each activity.
* I will learn the location and proper use of the safety equipment.
* I will report any accident, no matter how small, to the teacher immediately.
* I will follow the teacherís instructions during class and follow the clean-up procedures.
* I will perform home activities safely and with the knowledge and permission of my legal guardian.
Student (signature): ________________________________________†††† Date: _______________
Parent / Guardian: __________________________________________††† Date: _______________
LAB WARNING NOTICE
Sample Warning Notice: (Do NOT complete.)
Dear ______(Parent)_________:†††††††††††††††††††††††††††††††††††† Date: _______(MM/DD/YY)_________
This serves to notify you that during laboratory work today, _________(Your child)_______ broke lab rule: __ # 15 : They were randomly mixing chemicals in the lab.____________________________††††††† ___________.†
I have discussed the potential danger of this behavior with your child and trust you will also.† Further incidents may result in permanent removal from the laboratory.† Their safety, and the safety of those around them, cannot, and will not, be compromised.
Thank you for your cooperation in this matter.† Please sign below and return this sheet promptly.
Mr. Henry M. Skirbst, Lab Instructor
Parent Signature: ______(Your signature)______________††††††††††††† Date: ___(DD/MM/YY)_____