Full Name Student/Employee ID Department/Organization Date

Information on Hazardous Material

List of Hazardous Materials to be Handled Brief Description of Handling Procedures

Consent and Acknowledgement

I have been informed and understand the hazards associated with the materials listed above.
I have received training in the proper handling, storage, and disposal of hazardous materials.
I agree to follow all laboratory safety protocols and use the recommended personal protective equipment at all times.
I am aware of the emergency procedures in case of accident or exposure.
I understand that failure to comply with safety protocols may result in disciplinary action.

I have read and agree to the above statements.