Safety Contract & Bee Hive Permission

Name: _____________________________________ Academic Year: 2011-12 Science Teacher: ____________________________ Course: _______________ List any medical conditions here for which you are under doctor's care: ____________________________________________________ HONEY BEES To the parent/guardian: Laboratory exercises may include the observation and/or opening of a Honey Bee hive. Each student must have parent/guardian permission to visit the hives and/or interact with the Honey Bee environment. While the hives provide students with a rich opportunity to observe nature, participation in these events is not mandatory. Please answer the questions below and affirm your decision by signature in the space provided. Does the student listed above have an allergy to bees? _____NO _____YES (Please x the appropriate space.) If yes, does the student named above have medication at school to help with an allergic reaction? ____NO ____YES (If yes, please write the name of the medication below.) Medication _____________________________________________ As parent/guardian, do you give permission for the student listed above to visit and interact with the bee hive under adult supervision? ____NO _____YES Parent Signature_______________________________ Date: _____________

Printed Name _______________________________

SAFETY IN LABORATORY COURSES To the student: You are required to read, understand and implement the safety precautions indicated in your laboratory manual or laboratory handouts, which are summarized below. Your signature indicates your absolute willingness to abide by these precautions while you are in the laboratory.

1. Work in the laboratory only as authorized by your teacher. Do not perform unauthorized experiments. Always
follow instructions and wait until you are told to begin before starting any investigation.

2. No loud talking during labs. 3. 9th grade students are required to purchase safety goggles from the PC store. All students are required to wear 4.
goggles as directed during laboratory sessions. Learn emergency procedures and know the locations of the nearest eye wash, chemical cleanup materials, fire extinguishers, showers, and fire blankets. If you get chemicals in your eye(s), wash immediately with flowing water from the eyewash for 15-20 minutes. Inform the instructor immediately of any accident. Safety procedures will be outlined and hazardous chemicals will be indicated at the start of every experiment. If you are injured or if any type of accident or fire occurs, IMMEDIATELY call your teacher for assistance. Carefully read all instructions and thoroughly plan your work. Wear appropriate clothing and closed-toe shoes in the lab. You may also be required to wear aprons. Confine long hair and loose jewelry. Carefully read all labels on chemical bottles and familiarize yourself with the number/color hazards codes. Never return excess chemicals to the stock bottles. Do not put a pipet or a dropper directly into a commercial stock reagent bottle. Instead, pour an aliquot of the reagent from the stock bottle into a beaker. Use premixed lab reagents as directed in the instructions for specific laboratory exercises.

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9. Do not eat or drink in the lab. Never taste chemicals. Smell chemicals cautiously by wafting the vapors toward
you. 10. When mixing or heating chemicals in a test tube, point the test tube away from people. 11. Do not use bunsen burners or other sources of spark or flame in the vicinity of flammable liquids. Note that most organic solvents are flammable. Check burner set-up with your instructor before lighting. Never leave a lit burner unattended. 12. Exercise caution when handling equipment. Hot glassware and crucibles look the same as cold equipment! 13. Dispose of all acidic solutions by pouring them into the acid-neutralization jug, and all alkaline solutions in the alkali-neutralization jug. 14. Fill a pipet by using a pipet bulb or mechanical pipettor only; never pipet by mouth. 15. If a spill occurs, notify your teacher immediately. Do not attempt to clean the area yourself. 16. Wash off splashed chemicals (i.e acids and bases, salt solution) with copious amounts of water. If it is a large spill, use the safety shower. Inform your instructor immediately in all cases of spills and accidents. 17. Dispose of chemicals/sharps as directed by your instructor and in a manner consistent with federal, state and local hazardous waste disposal regulations. Organic solvents are never to be disposed of down the sink; receptacles will be provided as needed for their collection. 18. Exercise care and caution when handling all equipment, especially sharp instruments and power tools. 19. Goggles must be worn at all times when using power tools and saws, or when in the vicinity of a powered tool. 20. Exercise caution when using electrical equipment. Always follow the instructions provided by the manufacturer, lab notes, and your teacher. 21. Push chairs under lab bench when doing an experiment unless instructed otherwise. Do not sit on lab benches during labs. 22. Never enter the lab/classroom when an instructor is not present. Wait in the hall until the teacher arrives. 23. In the event of a fire drill, take goggles and aprons outside with you. 24. Carefully read all labels and MSDS sheets before using or measuring a substance. 25. Keep your hands away from face, mouth, eyes and body during experiments and wash them after every experiment or lab period. 26. Keep your work area clean. Keep all books and other nonessential items away from the work area. Dispose of waste materials in appropriate containers. 27. Never use cracked or broken glassware. Label all materials when in use. 28. Clean all sinks, counters, and equipment at the end of each lab. Return equipment to its proper place. AFFIRMATION: I have read carefully and understand all of the safety rules contained on this document. I also agree to read all rules for specific exercises contained in the laboratory manual or laboratory handouts required for this course. I recognize that it is my responsibility to obey them faithfully. I realize that all chemicals are potentially dangerous; therefore I will exercise care in handling them. If I am unsure of the potential hazards of any chemical, I will discuss this with my teacher prior to using the chemical in question. I understand that I am required to wear safety goggles at all times when directed to do so in the laboratory. I also understand that there are dangers involved in wearing all types of contact lenses in laboratory situations where reactive chemical agents, biological fixatives, or volatile organics are in use. I am aware that even when safety goggles are worn, the Science Department strongly discourages wearing of contact lenses in these situations. If I do elect to wear contact lenses in the laboratory, I will inform my teacher and I will assume all responsibility for damages caused by wearing them in the lab. If I have a medical condition such as, but not limited to, hypo- or hyperglycemia, diabetes, epilepsy, pregnancy, heart ailments, or any other medical condition which may cause sudden loss of consciousness, I certify that I am under a doctor's care and that my doctor has given me explicit permission to participate in this laboratory course. I will inform my teacher of my condition at the beginning of the trimester, or as soon as I am aware of the existence of the medical condition. I FURTHER UNDERSTAND THAT I AM PERMITTED TO WORK IN THE LABORATORY ONLY WHEN IT IS UNDER THE SUPERVISION OF A SCIENCE TEACHER, UNLESS SPECIFICALLY INFORMED OTHERWISE. Your Signature _________________________________________Date __________ Your Name (print) __________________________________________ Your teacher will collect and retain this document. For your reference and review, a copy is available on your teacher's website.