Sample Safety Contract – Lab Notebook Page 1


Exp #:



Laboratory Safety Contract


Title Page


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Page 01




Lab Partner:    


CHM 1025 C

Section #



Name: _________________________         Email: ____________________________


Address: _______________________          2nd Email: _________________________


_______________________________         Phone #: __________________________


                         __________________          Cell Phone: ________________________



Course:  CHM 1025C

Section #: __________


Professor: John T. Taylor


I, ____________________________, have watched the ACS Laboratory Safety Film. I have read the different sets of Safety Rules from various colleges provided by my instructor. I have synthesized from these rules and the safety film a list of at least 20 rules written in this Laboratory Notebook which I agree to abide by during all formal laboratory activities and experiences in FSCJ North Campus’s D-204 Chemistry Lab. I agree to wear proper safety glass at all times during lab activity, regardless if I, myself, am not currently performing any activity. I agree to lose points on my current lab if I am not wearing these safety glasses. I understand that protective aprons, gloves and lab coats are available at my option to use during formal lab activity. I have sketched in this laboratory notebook, the layout of the North Campus Chemistry Lab D-204 and have noted the placement of all safety features, equipment and supplies in this Post Lab Safety Report.


Signed: _______________________Date:________________







Florida State College @ Jacksonville                                North Campus