Copyright Goodheart-Willcox Co., Inc. May not be reproduced or posted to a publicly accessible website. ix Verification of Laboratory Safety Rules and Regulations I have read the General Laboratory Safety Rules and Regulations and understand their importance. I agree to follow these guiding principles as well as any additional rules and regulations provided by my instructor. I understand that failure to follow lab safety rules and regulations may result in my removal from the lab and course. Course in which this document applies (course name and number): _____________________________________________________________________________________________________________________ Term/Year: _____________________________________________________________________________________________________________________ Instructor: _____________________________________________________________________________________________________________________ Name (print): ____________________________________________________________________ Signature: ____________________________________________________________________ Date: ____________________________________________________________________ Emergency Contact Information Should an emergency occur while in the laboratory setting, please contact the following individual(s): Name: ____________________________________________________________________ Contact Number: ____________________________________________________________________ Additional Information (if needed): _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ _____________________________________________________________________________________________________________________ ** Submit this completed form to your instructor **