Student’s Name:
Period:
PHYSICAL SCIENCE STUDENT SAFETY PLAN
There is an electronic copy of this form on the website for your information and reference; I suggest printing a copy
for your reference. One copy must be signed by both student and parent/guardian before the student can
participate in labs in which chemicals, other than water, are used (students are responsible for any labs missed while
the form has not been signed and returned to instructor).
1. Conduct yourself in a responsible manner at all times in the laboratory.
a. Only experiments and lab activities designed by or approved by the instructor will be performed.
b. Read the lab instructions before beginning any experiment or lab activity.
c. If you do not understand the instructions or procedures, ask the instructor before proceeding.
d. Lab activities will be conducted only when the instructor is present in the room.
e. Note all safety instructions and warnings in instructions and from the instructor.
2. Observe safe Handling of chemicals in the lab setting
a. Wear safety goggles when handling, transporting, stirring, heating, etc. ANY chemicals
b. Treat all chemicals in the laboratory as if they are dangerous.
c. NEVER touch, taste, or smell any chemicals unless specifically instructed to do so.
d. Review the hazards for all reagents from data given in the lab instructions, MSDS, or other appropriate
reference.
e. If you are asked to smell a substance, do so by wafting over the substance to your face with your hands,
rather than putting your face over the substance.
f. Check the label on chemical bottles twice before removing any of the contents. Take only as much chemical
as you need.
g. Never return unused chemicals to their original containers.
h. When transferring reagents from one container to another, hold the containers away from your body.
3. Always follow instructions for mixing, heating and handling all reagents. DO NOT attempt any unauthorized
procedures.
4. Inappropriate behavior such as practical jokes, horseplay, deliberately inhibiting another students movement,
splashing, spilling, or squirting reagents on another will not be tolerated. This will result in immediate removal
from class. After removal, depending on severity of infraction, students may not be readmitted until after meeting
with the teacher and an administrator to determine to evaluate their behavior.
5. Personal protection equipment will be worn when required by the instructor, or when indicated by the safety
notes in the lab instructions.
a. Splash goggles
b. Thermal or chemical resistant gloves
c. If you wear contact lenses, notify the instructor. The use of contacts may result in additional hazard.
6. Due to increased possibility of spills, burns or contamination the following types of apparel should not be worn
during a lab activity:
a. Shorts and short skirts
b. Outer wear such as coats, jackets and sweaters
c. Sandals, open shoes, or bare feet
d. Dangling jewelry
e. Very loose clothing, including fringes and tie strings.
7. Observe safe glassware use:
a. Examine glassware before each use. Never use chipped or cracked glassware. Never use dirty
glassware.
b. Never handle broken glass with your bare hands. Use a brush and dustpan to clean up broken glass. Place
broken or waste glassware in the designated glass disposal container.
c. If glass is heated it will remain hot for a long time, allow to glass to cool and then pick up with extreme
caution (hot glass and cold class can look identical)
8. Know the location and operation of all safety equipment in the room.
a. Eye-wash station
b. Deluge shower
c. Fume hood
d. Fire extinguisher
e. First-aid kit
9. Know the location of the exits and the procedures for evacuation.
a. Keep all aisles clear
b. Keep the counters, tables and floor clear of clutter and debris.
10. Work only in the designated areas. Observe "off-limit" designations (behind Mr. Uitvlugt’s desk or demonstration
areas, prep room, and others specified by the teacher.
11. Do not eat, drink or apply makeup in the lab!
12. Clean up your work area when finished with the lab activity.
a. Clean and return all equipment to the designated area.
b. Place waste in the proper receptacles. DO NOT put lab wastes down the sink unless instructed to do so.
c. Wash your lab table.
13. After any lab activity, wash your hands before you leave the room using soap and water.
14. Vandalism will not be tolerated. Students involved in vandalism will be removed from class and will be held
responsible for property damage and personal injuries to self and others.
Print your name, and sign and date below to indicate you have read the laboratory safety rules and agree to abide by
them.
Student Name (please print):
Please check all of the following that apply that will help Mr. Uitvlugt know any other safety precautions for you.
☐ I wear contact lenses
☐ I am color blind
☐ I have allergies
☐ sometimes
to which colors:
to:
☐ most of the time/always
Student Signature:
Date:
Parent/guardian Signature:
Date: