CBME Risk Assessment Audit Declaration

I, _________________, have read and understood the relevant sections of the HKUST
Safety and Environmental Protection manual. I am aware of my responsibilities with
regard to the health and safety of myself and others and state that, to the best of my
knowledge, the information provided in this work plan is complete and correct :
I have attended and passed the following safety courses :

1.
2.

Hazardous Waste Management (mandatory) ___MC03

Chemical Safety for Laboratory Users (mandatory)__MC07

3.
4.
5.
6.
7.

Fire Safety (mandatory)

Laser Safety___MC04
Biological Safety___MC06
Pressure Safety___MC05
Others :

Are any of the following categories relevant to the proposed research?

High voltage power supplies

Biologically active materials
Radioactive materials or ionising radiation
sources
Non-ionising radiation (UV, microwaves, lasers)
Highly toxic, carcinogenic or mutagenic materials
Highly flammable or explosive materials
Operation
under
extreme
pressure
or
temperature

Yes
Yes

No
No

Yes

No

Yes
Yes
Yes

No
No
No

Yes

No

Status of Researcher
1. HKUST CBME

HKUST______

Non HKUST______

2. Ph.D.
FYP
Visiting Scholar
Intern-PG
Intern-UG
UG Research

M.Phil.
UROP
Research Assistant
Exchange-PG
Exchange-UG

Others______

M.Sc.
Student Helper
Research Associate
Post Doc
Faculty

______________________

Insurance Coverage
All researchers other than undergraduate or postgraduate students must provide a
copy of their letter of appointment to ensure that they have official status within the
Department and that they have appropriate insurance coverage. Any researchers
employed by anyone other than the Department of Chemical and Biomolecular
Engineering at HKUST, must provide full details of their insurance coverage by their
employer.
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Assessment checked by Technical staff associated with ALL laboratories in which

the planned EXPERIMENTAL work will be undertaken.
Laboratory

Responsible Technician (Name)

Signature

Date

Please list ALL laboratories in which ANY ANALYTICAL work will be undertaken:
Analytical Lab (7101),
Spectroscopy and Surface Characterization (7106)
Material Processing and Characterisation (7119)
Laboratory

Responsible
Technician Name

Equipment

Training Required
Y/N

Training Completed
Y/N

Note: After completion of training, a record of training completion will be recorded and
kept by the relevant technician

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I have had my work plan checked by the relevant technical staff associated will all
laboratories in which the planned work will be undertaken and also by my Faculty research
supervisor. I have considered their suggestions and feedback and have modified the work
plan accordingly.
Researcher
Name

Signature

Date

Assessment checked by research supervisor(s)

Name

Signature

Date

Name

Signature

Date

Authorized by CBME Departmental Safety Officer (DSO)

Name

Professor John Barford

Signature

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Date