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STATEMENT
I, the undersigned
_______________________________________________________
(print name)
hereby declare that I have read the Reed College chemistry department’s Manual for Chemical Safety, edition number fourteen, dated April 2004, and that I have understood its contents. I hereby undertake not to engage in any laboratory work whatsoever except that covered by the statement titled "Normal operating hours and conditions of work in the chemistry department" on page 2 of the above manual.
In particular, I agree never to undertake experimental work, or to remove chemicals or equipment from the chemistry building, without written prior approval of my instructor.
I understand that any chemistry building activity on my part that is counter to the regulations in this booklet may result in disciplinary action by the chemistry department or by the college. In the case of persistent and/or severe infringement of the regulations, I may expect to be denied registration in the college.
Signature ___________________________________________
Date ________________Name of student (print) ___________________________________________________Signature of witness _______________________________
Date ________________
Name of chemistry instructor witness ________________
PLEASE RETURN THIS PAGE, FILLED OUT IN ITS ENTIRETY, TO THE DEPARTMENT SECRETARY IN ROOM 303.
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