Laboratory Experiment – Safety and Risk...

Laboratory Experiment – Safety and Risk Analysis
Every student or student team that is planning to conduct a hazardous material or hazardous operation
experiment as part of undergraduate or graduate project must complete this sheet and review the
information and analysis with the laboratory manager and faculty advisor. The advisor and laboratory
manager must review and sign this risk and safety analysis form prior to the start of the experiments.
(If additional space is needed, please attach additional pages)
Date: ___________________
Student Names: ______________________ _________________________________________________
Advisor Name: ____________________________________Department: __________________________
Experiment name: _____________________________________________________________________
Experiment description: (describe the experiment, where will it be conducted, what equipment is
needed, etc): _________________________________________________________________________
Hazards identified (high temperatures, low temperatures, acids or bases, solvents, high pressure, sharp
objects, pinching or cutting, etc): ___________________________________________________
Safety Issues: ________________________________________________________________________
Safety precautions: ___________________________________________________________________
Risk assessment: _____________________________________________________________________
Training required? ____________________________________________________________________
Experimental Procedure (describe the step by step experimental procedure, include the safety
equipment required and safety procedures and precautions to be followed): _____________________
Student Signature(s): __________________________________________________________________
Laboratory Manager: ________________________Advisor Signature:___________________________
A copy of this completed form must be sent to the EHS Office in the Facilities Dept.