Manitoba

Manitoba Education

Science Safety

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Appendix C

Student Safety Contract
Contact Lens Information Sheet

Student Safety Contract

Checklist:

  • Course/grade/section
  • Teacher in charge
  • Name of student
  • List of agreements
  • List of understandings
  • Date of agreement
  • Student signature
  • Parent signature(s)

These headings are the minimum suggested for inclusion in a contract. Your school division/district policy may include other requirements.

Please print      
       
Course/Grade ____________________ Section __________________________
       
Teacher ________________________________________________________

 

 I, ____________________________________, agree to:

  • follow all instructions given by the teacher
  • protect my eyes, face, hands, and body when involved in science
    experiments
  • carry out good lab housekeeping practices
  • learn the location of the first aid kit, eye wash, fire blanket, and
    fire extinguisher
  • conduct myself in a responsible manner at all times

I have been instructed in lab safety and emergency techniques needed for my science class. I have made a grade of 100 per cent on the lab safety examination which allows me to participate in lab activities. I understand and agree to follow the lab safety rules above and in the Lab Safety Guide I received from my teacher. I am aware that my safety and the safety of my classmates depends on my behaviour in the lab. I will follow closely all written and oral instructions provided by my teacher and/or the school administration.

Date __________________________________________
   
Student signature __________________________________________
   
Parent /Guardian signature(s) __________________________________________
   
  __________________________________________

 

Contact Lens Information Sheet

Checklist:

  • Course/grade/section
  • Teacher in charge
  • Name of student
  • List of agreements
  • List of understandings
  • Date of agreement
  • Student signature
  • Parent signature(s)

These headings are the minimum suggested for inclusion in a contract. Your school division/district policy may include other requirements.

Please print      
       
Course/Grade ____________________________ Section ____________________
       
Name of student ____________________________    
       
Teacher ____________________________    
       
Date ____________________________    


Check the appropriate spaces

____ I do not wear contact lenses

____ I wear contact lenses.

The type is ______________________________ (Hard/soft, extended wear/regular wear)

During lab experiments I will

____ remove contacts and wear regular glasses along with protective
eye wear appropriate to the experiment being done
   
____ continue wearing contacts and use protective eye wear appropriate
to the experiment being done and splash-proof goggles at all other times
   
____ read the student handout on eye safety and follow all the
requirements


If the situation changes at any time during the school term, I will notify the teacher immediately.

Student signature __________________________________________
   
Parent/Guardian signature(s) __________________________________________
   
  __________________________________________

 


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