Acknowledging Safety Rules and Enforcement Requirements Form

Must be on file with Lab Coordinator BEFORE laboratories begin

Laboratory Instructor Name (print):______

Place your initials after each statement.

I and my students will read the “lime green” safety rules together. I will turn in the signed green forms to room 201.______

I understand that I, as a laboratory instructor, am subject to the same safety rules as my students. Thus, I understand that I must wear the same type of safety goggles (and clothing) the students are required to wear while I am supervising an undergraduate teaching laboratory.______

I must explicitly discuss with students the departmental goggle policy and violation consequences on the first day of lab. ______

I understand that part of my supervisory role is to enforce all safety rules. ______

  • Thus, I MUST send improperly dressed students home.______
  • Thus, I must follow departmental procedures for goggle violations. ______
  • I must remind students about the goggle policy before each lab begins.______
  • I must give a student a verbal warning if he/she is observed not to be wearing goggles. I must explicitly remind the student about the consequences of a second violation.______
  • If the student is observed violating the goggle policy a second time in the same lab period as the verbal warning was given then I must penalize that student’s lab report by 50% . ______
  • Finally, if a student is observed violating the goggle policy a third time in the same lab period as the verbal warning then I must dismiss that student from the laboratory for that day. This dismissal will result in a zero grade for that lab report. ______
  • I must inform the laboratory coordinator of all second and third violations by email. ______

I understand that, in the event of an accident, I must fill out an accident report form and give a copy of the completed form to Ken M and the Lab Coordinator. These forms are available in 201. Accidents are NOT limited to incidents which result in an injury.______

I understand that part of the requirements of my employment as an instructor is to attend the regularly scheduled T.A. meetings. One reason this is important is because safety information is discussed.______

See reverse side

I understand that not complying with the statements I initialed above (including enforcement) will result in punitive measures against me. These measures may include such things as a written warning, a meeting with the safety committee, an unsatisfactory teaching grade, and/or the possibility of no further teaching support. ______

Instructor Signature

Date

Coordinator signature and date