Department of Chemical Engineering and Technology

Mindanao State University – Iligan Institute of Technology

LAB FORM 1: LABORATORY USE PERMIT

 Prepare 2 copies. Regular working hours are on weekdays only.
 Work beyond regular hours (8:00 AM – 5:00 PM) requires the presence of a supervisor and an
approved LAB FORM 2.
 This form is to be submitted at least 3 working days prior to the start of work.

Date of Application:

School Year and Semester:

Degree and Program of Study:

Name(s) and Contact Number:

Title of Experiment:

Equipment to be Used:

Hazardous Chemicals Involved:

Location of Experiment:

Adviser’s Endorsement:
(name and signature)

HSE Officer’s Endorsement:

(signature)

Laboratory Head’s Approval

(name and signature)

For Admin Use Only:

[ ] Passed the LUOSS Exam (Date: _________________) Verified by: ____________
Attachments for first-time researchers (to be renewed/updated every semester):
[ ] LAB FORM 3: Risk Assessment Form
[ ] LAB FORM 4: Waste Management Plan
[ ] Photocopy of Insurance Policy
[ ] Waiver and Release from Liability Form