SAMPLE
XYZ
Charter
719
555/555-1234
Student Science
Laboratory Safety Contract
Name:_________________________________________Date:
_______________________
I
agree to:
- Act responsibly at
all times in the laboratory.
- Follow all
instructions given, orally or in writing, by my teacher.
- Perform only those activities assigned and
approved by my teacher.
- Protect my eyes, face, hands, and body by
wearing proper clothing and using protective equipment provided by my
school.
- Carry out good housekeeping practices as
instructed by my teacher.
- Know the location of safety and first aid
equipment in the laboratory.
- Notify my teacher immediately of an
emergency.
- NEVER work alone in the laboratory.
- NEVER eat or drink in the laboratory unless
instructed to do so by my teacher.
- Handle living organisms or preserved
specimens only when authorized by my teacher, and then with respect.
- NEVER enter or work in a supply area unless
instructed to do so and supervised by my teacher.
[This portion of the
contract is to be kept by the student.]
[Return this portion
to your teacher.]
I,
[print name] have read each of the statements
in the Student Science Laboratory Safety Contract and understand these
safety rules. I agree to abide by the
safety regulations and any additional written or verbal instructions provided
by the charter or my teacher. I further
agree to follow all other written and verbal instructions given in class.
Student
Signature: _________________________________ Date: _____________________
I acknowledge that my child/ward has
signed this contract in good faith.
Parent/Guardian
Signature: __________________________ Date: _____________________
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