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.