Visitor Participation agreement
Laboratory use addendum
for
Non-Pitt Personnel Using Pitt Research and Laboratory Facilities
In consideration for my use of Pitt’s research and laboratory facilities (collectively, the “Facilities”), I agree as follows:
- Access to Facilities. The Facilities are being made available to me as an educational or research opportunity.
- Health and Safety Risks. I understand that the Facilities may contain hazardous or dangerous substances, equipment or procedures. I will take every precaution necessary to protect my health and safety, and the health and safety of others. I will acquaint myself with and conduct my activities in accordance with all safety rules and safe operational procedures which can be found at: If I am not familiar with or I do not know how to safely handle a substance or piece of equipment, I will seek assistance from qualified Pitt personnel. I recognize that I may be subjected to potential risks, illnesses, and injuries.
- No Medical Coverage. I understand that if I am injured as a result of my activities at Pitt, I am not covered by Pitt insurance of any kind. It will be my responsibility to pay for emergency room care, doctors’ services, hospitalization and any other related costs, medical or non-medical. I will not be eligible to participate in Pitt’s health, disability or life insurance program.
- Appropriate Conduct. I agree to observe all applicable governmental, Pitt and departmental policies, rules and regulations that pertain to my conduct on campus and in the Facilities.
- ASSUMPTION OF RISK AND RELEASE OF CLAIMS. Knowing the risks described above, I agree, on behalf of my family, heirs and personal representative(s), AND THE HOME INSTITUTION AGREES to assume all the risks and responsibilities surrounding my use of and access to the Facilities. To the maximum extent permitted by law, I AND THE HOME INSTITUTION release and hold harmless Pitt, its trustees, officers, faculty, staff, representatives, volunteers, employees, students, other trainees and agents, and their respective heirs and assigns, from any and all claims, losses, expenses, damages, or liabilities which I OR THE HOME INSTITUTION may incur or suffer, arising out of or related to my use of or access to the Facilities.
- INDEMNIFICATION. I and/or the Home Institution agree to indemnify, defend and hold harmless Pitt, its trustees, faculty, staff, representatives, volunteers, employees, students, other trainees, and agents, and their respective heirs and assigns, against any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities (including reasonable attorneys’ fees) (collectively “Claims”), arising out of or related to my use of or access to the Facilities, but only in proportion to and to the extent that such Claims result from or are caused by my own negligent or intentional acts or omissions.
I have carefully read this Acknowledgement of Risk and Release before signing it. This agreement shall be governed by the laws of the Commonwealth of Pennsylvania, excluding its choice of law provisions. The forum for any lawsuits filed under or incident to this agreement shall be the state or federal courts located in Allegheny County, Pennsylvania.
Signature:______
Name:______
Title:______
Date:______
Initial one:
( ) I am supported by or affiliated with a Home Institution and agree to have an authorized representative of my Home Institution countersign below.
( ) I am not supported by or affiliated with a Home Institution. I understand that my signature above means I have the sole authority to agree to all terms of the Laboratory Use Addendum.
Home Institution Counter Signature:
The person signing below represents and warrants that he/she is duly authorized to sign this Visitor Participation - Laboratory Use Addendum on behalf of such Home Institution.
Home
Institution: ______
Signature:______
Name:______
Title:______
Date:______
University of Pittsburgh Approval:
Signature:______
Name:______
Title:______
Date:______
February 2018