ScienceSafetyContract

SchoolName____________________________
Teacher__________________________

StudentName_____________________________________________(Print)Class
__________________________

Purpose

Scienceisahandsonlaboratoryclass.However,scienceactivitiesmayhavepotentialhazards.
Studentswillusesomeequipment,chemicals,andanimalsthatmaybedangerousifnothandled
properly.Safetyinthescienceclassroomisanimportantpartofthescientificprocess.Tohelp
ensureasafeclassroom,alistofruleshasbeendevelopedandwhensigned,willbecomeaScience
SafetyContract.Theserulesmustbefollowedatalltimes.Additionalspecificsafetyinstructionswill
beexplainedforeachactivity.Therulesareprovidedtoprotectstudentsandstaffsothateveryone
benefitsfromthelab.

Nosciencestudentwillbeallowedtoparticipateinscienceactivitiesuntilthiscontracthasbeen
signedbyboththestudentandaparentorguardian.

1. Conductyourselfinaresponsiblemanneratalltimesinthescienceroom.Horseplay,
practicaljokes,andprankswillnotbetolerated.
2. Followallwrittenandverbalinstruction.Askyourteacherquestionsifyoudonotunderstand
theinstructions.
3. Donottouchanyequipment,supplies,animals,orothermaterialsinthescienceroom
withoutpermissionfromtheteacher.
4. Performonlyauthorizedandapprovedexperiments.
5. Nevereat,drink,chewgum,ortasteanythinginthescienceroom.
6. Keephandsawayfromface,eyes,andmouthwhileusingsciencematerialsorwhenworking
witheitherchemicalsoranimals.Washyourhandswithsoapandwaterbeforeleavingthe
scienceroom
7. Wearsafetygoggleswheninstructed.Neverremovegogglesduringanexperiment.There
willbenoexceptionstothisrule.
8. Cleanallworkareasandequipmentattheendoftheexperiment.Returnallequipmenttoits
properlocation.
9. Followyourteacherinstructionstodisposeofanywastematerialsgeneratedinan
experiment.
10. Reportanyaccident(fire,spill,breakage,etc.),injury(cut,burnetc.)orhazardouscondition
(fire,unintendedchemicalreaction,etc.)totheteacherimmediately.
11. Considerallchemicalsusedinthescienceroomtobedangerous.Donottouchorsmellany
chemicalsunlessspecificallyinstructedtodoso.
12. Handleallorganismswithcareandrespect.Specificruleswillapplyforeachorganism.
GreatTeaching.GreatLearning.EveryStudent.EveryDay.

13. Alwayscarryamicroscopewithbothhands.Holdthearmwithonehandandplacetheother
handunderthebase.
14. Treatallpreservedspecimensanddissectingequipmentwithcareandrespect.
15. Neveropenstoragecabinetsorentertheprep/storageroomwithoutpermissionfromthe
teacher.
16. Donotremovechemicals,equipment,supplies,ororganismsfromthescienceroomwithout
permissionoftheteacher
17. Handleallglasswarewithcare.Neverpickuphotorbrokenglasswarewithyoubarehands.
18. Useextremecautionwhenusingmatches,aburner,orhotplate.Onlylightburnerswhen
instructedanddonotputanythingintoaflameunlessspecificallyinstructedtodoso.Donot
leaveaburnerunattended.
19. Dressappropriatelyforthelaboratorylonghairmustbetiedback,nodanglingjewelryand
nolooseorbaggyclothingshouldbeworn.Wearapronswheninstructed.
20. Learnwherethesafetyequipmentislocatedandhowtouseit.Knowwheretheexitsare
locatedandwhattodoincaseofanemergencyorfiredrill.

ImportantQuestions

Doesyourchildwearcontactlenses?(CircleOne)

YesorNo

Doesyourchildhaveanyallergies?(CircleOne)
YesorNo
orotherMedicalProblems?( Thatcouldaffecttheirparticipationinscience)

Ifyes,pleaselist:

AGREEMENT

I,_______________________________________(studentname)havereadandunderstandeachoftheabovesafetyrulessetforthinthis
contract.Iagreetofollowthemtoensurenotonlymyownsafety,butalsothesafetyofothersinthescienceclassroomorlaboratory.I
alsoagreetofollowthegeneralrulesofappropriatebehaviorforaclassroomatalltimestoavoidaccidentsandtoprovideasafelearning
environmentforeveryone.IunderstandthatifIdonotfollowalltherulesandsafetyprecautions,Iwillnotbeallowedtoparticipatein
scienceactivities.

____________________________________________________________________________
______________________________
StudentSignature
Date

DearParentsorGuardians:
AlleganyCountyPublicSchoolsiscommittedtoestablishingandmaintainingasafescienceclassroom/laboratoryenvironment.Please
readthelistofsafetyruleswithyourchild.Nostudentwillbepermittedtoperformscienceactivitiesunlessthiscontractissignedbyboth
thestudentandparent/guardianandisonfilewiththeteacher.YoursignatureonthiscontractindicatesthatyouhavereadthisScience
SafetyContract,revieweditwithyourchild,andareawareofthemeasurestakentoensurethesafetyofyourson/daughterinthescience
classroom.PleasebesuretoanswertheImportantQuestions.

GreatTeaching.GreatLearning.EveryStudent.EveryDay.

____________________________________________________________________________
______________________________
StudentSignature

Date

*Derivedfrom2011FlinnScientific,Inc.StudentSafetyContract.ReproductionpermissionisgrantedtoscienceteacherswhoarecustomersofFlinnScientific,Inc.Batavia,Illinois,U.S.A

GreatTeaching.GreatLearning.EveryStudent.EveryDay.