Science Safety
Appendix C
Student Safety Contract
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 | __________________________ |
| 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) | __________________________________________ |
| __________________________________________ |
