Cummings High School Lab Safety Agreement
Course__________________________
Teacher_________________
This is to certify that I, _________________________________ have been instructed in and understand the
following safety components of this science course.
In science classes, you will frequently perform laboratory activities. While no human activity is completely free of
risk, if you use common sense and a bit of scientific sense, you will encounter no problems. These safety rules
apply to all laboratory activities and must be followed in order for you to participate in laboratory activities.
Please read this over carefully. Have a parent or guardian read this agreement and sign the space on the back. Then
please return the signed form to your teacher.
RULES OF LABORATORY CONDUCT
Student Initials_____
I. FOLLOWING INSTRUCTIONS
a. Only perform those activities where instructions and permissions have been given by your teacher.
b. Only use materials and equipment authorized by your teacher.
c. Read and think about each lab assignment and the related safety issues before you start.
d. Follow carefully both the written and verbal instructions given by your teacher.
e. Perform laboratory work only when your teacher is present.
Student Initials_____
II. USING EQUIPMENT
a. Know the location and use of all safety equipment in your laboratory (eye wash, first aid, fire extinguisher).
b. Wear protective goggles when requested for laboratory work.
c. Clear your lab table of all unnecessary materials such as books and bags before you start.
d. Do not wear sandals, tie back loose hair, roll up long sleeves.
e. Only use the lab equipment according to the instructions given by your teacher.
Student Initials_____
III. BEHAVING APPROPRIATELY
a. Avoid unnecessary movement and talking.
b. Upon entering the classroom, do not touch lab equipment until given permission by your teacher.
c. Do not enter the science supply room unless given permission by the teacher.
d. Do not handle living organisms without teacher permission.
e. Show respect to any living organisms that are in the laboratory.
Student Initials_____
IV. PRACTICE GOOD TECHNIQUES
a. Check chemistry labels twice to make sure you have the correct substance.
b. If you are asked to transfer laboratory chemicals from a common bottle or jar to your own test tube or beaker,
do not return any excess material to its original container.
c. To note the odor of fumes, use a wafting motion of the hand. Never breathe deeply from a bottle.
d. Never taste, smell, or touch chemicals unless specifically instructed to do so.
e. Do not bring food or beverages to the science classroom.
f. Do not bring excess school materials to class.
g. Do not bring personal grooming products such as perfumes, colognes, or other cosmetics to class.
h. Do not bring any substances in contact with a flame unless specifically instructed to do so.
i. Never pour water into acid. Correctly dilute acid by pouring it into water.
l. Never allow the open end of a test tube to be pointed toward anyone. Never look directly into a test tube; view
contents from the side.
Student Initials_____
V. RESPONDING IN AN EMERGENCY
a. Report all accidents, no matter how small, to your teacher immediately.
b. Remove broken glass from the work area and floor as soon as possible. Do not use bare hands.
c. Know the proper fire drill procedure and where to get help fast.
d. In case of a chemical spill on your skin or clothing, rinse the affected area with plenty of water. If the eyes are
affected, water washing must begin immediately and continue for 10-15 minutes.
e. Minor skin burns should be placed under cold running water.
Student Initials_____
VI. CLEANING UP
a. When discarding used chemicals, carefully follow the instructions provided.
b. Do not discard solid substances in the sink.
c. Return equipment and chemicals to their designated locations.
d. Clean and wipe dry all desks, tables, or laboratory work areas at the conclusion of lab.
e. Before leaving the laboratory, ensure that gas and water faucets are turned off.
f. Wash hands at the conclusion of every laboratory period.
Response to Student Violation of Rules
First offense
Second offense
Third offense
Verbal warning from teacher.
Written assignment replacing that days lab.
Removal from lab activities; referral to the administration.
If any violation of the rules puts others in harms way, you will immediately be removed from the laboratory
activities; be referred to the administration, and will earn a zero for that lab grade.
NOTE: YOU WILL BE CHARGED FOR ANY AND ALL DAMAGE DONE TO LAB
STATIONS, LAB EQUIPMENT, OR COMPUTERS.
In order to assure my personal safety, it is important that the above rules are followed. Failure to do so
may result in my removal from the lab. I understand these rules and agree to abide by these rules and all
other written and verbal instructions given in class.
Date_______________
Student Signature_________________________________________
Your student will be working in the laboratory during this course. In order to assure their personal safety,
it is important that the above rules are followed. Failure to do so may result in your student being removed
from the lab. I understand these rules and agree that my student will abide by these and all other written
and verbal instructions given in class.
Date ____________________
Parent/Guardian signature _____________________________