Lisle Junior High School – Science Department
Student’s Name: ____________________________________________Period: ______ Date: ____/____/____
Violation:
 Rule 1 Violation: Dangerous, disrespectful, or irresponsible behavior.
 Rule 2 Violation: Failure to wear proper attire for laboratory activity.
 Rule 3 Violation: Failure to keep work area tidy and clean.
 Rule 4.A Violation: Unapproved use of equipment, supplies, organisms, or other materials.
 Rule 4.B Violation: Unapproved touching of equipment, supplies, organisms, or other materials.
 Rule 5 Violation: Failure to follow laboratory instructions.
 Rule 6 Violation: Failure to maintain personal safety.
 Rule 7.A Violation: Failure to wear proper eye protection during laboratory activity.
 Rule 7.B Violation: Failure to wear and use safety equipment.
 Rule 8 Violation: Failure to report accident.
 Rule 9 Violation: Failure to clean up laboratory activity.
 Rule 10 Violation: Failure to follow safety instructions.
 Other: ____________________________________________________________________________
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Comments:
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Notice: This violation must be signed by the student and parent/guardian in order for the student to resume participation in science laboratory activities. The student and parent/guardian signature indicate that the student and parent/guardian have reviewed the Science Laboratory Safety Violation and Rules.
Student Signature: _________________________ Parent/Guardian Signature : _________________________

A student will be removed from the science laboratory immediately for his/her personal safety and the safety of all other students if the rules listed below are not followed.
1.
Conduct yourself in a respectful and responsible manner at all times in the science laboratory!
2.
Clothing Requirements: Long hair, baggy clothing, dangling jewelry, sandals, and shorts, skirts/dresses are safety hazards in the laboratory. To participate in science laboratory activities:

Long hair must be tied back.
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Clothing must be fitted.
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Dangling jewelry must be removed.
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Closed-toe shoes and pants must be worn. (No sandals, shorts, skirts/dresses will be allowed.)
3.
Laboratory Environment: Work areas and equipment should be kept clean and neat at all times.
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Bring only your science book and writing instruments to the work area.
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Books or supplies should not be placed on the laboratory counters or floor.
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Books and supplies not related to the science laboratory activities should be placed in the student’s assigned drawer or locker.
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Jackets, bags, or purses are not allowed in the science laboratory.
4.
Equipment: Do not touch any equipment, supplies, organisms, or other materials in the science laboratory and classroom without permission from the teacher. Use equipment only as directed by teacher.
5.
Instructions & Lab Activities: Follow all written and verbal instructions carefully. Ask questions if you do not understand the instructions. Perform only approved science laboratory activities, and do not stray from the instructions
6.
Personal Safety: To keep ourselves safe, we must take safety precautions in the science laboratory:

Wash your hands with soap and water before and after the science laboratory activity.

Never eat, drink, chew gum, or taste anything in the science laboratory.
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Never put on makeup or Chap Stick in the science laboratory.
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Keep hands away from face, eyes, and mouth while using science laboratory materials.
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When directed to “sniff” in the lab, do not place nose over item. Follow the teacher’s directions for “wafting” the odor to the nose.
7.
Safety Equipment: Wear and use safety equipment including goggles, gloves, and safety tongs or mittens.
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Never remove safety goggles during a science laboratory activity. There are no exceptions to this rule!
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Cold or very hot materials can only be touched with heat safety items such as safety tongs, safety mittens, or rubber gloves.
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Wear safety gloves and do not remove the gloves unless instructed to do so.
8.
Accidents: Report any accident (spill, breakage, etc.), injury, or broken equipment to the teacher immediately.
Glass should be used cautiously and chipped, cracked, or scratched glassware should never be used.
9.
Clean Up: It is expected that laboratory students will clean all work areas and equipment at the end of an activity.
Students must follow teacher instructions to return equipment properly and discard waste materials safely.

10.
Emergency: Learn where the safety equipment is located and how to use it. Know where the exits are located and what to do in case of an emergency or fire drill. If there is an Emergency, yell: Code 1.