CONSENSUS LETTER

I willingly participate in the 13th National Chem-E Car Competition 2018 on my own risk. I had fill in the
Risk Assessment Form and Chemical Hazard Risk Phrase Form in Appendix A and Appendix B. I doing so,
I have read and understand every Safety Data Sheet of chemicals that will be used. I acknowledge that in this
competition, it may involve usage of chemical which is inherently dangerous, I may suffer injury, illness or
death. I assume the risk of, and the responsibility for, any injury, illness, death or damage to or loss of
property resulting from my participation in any activities and will not seek to penalize, prosecute or claim
compensation from the organizers, suppliers, sponsors, presenters or participants.

I understand that, except as otherwise agreed to by the organizer in writing, the organizer does not carry
or maintain health, medical or disability insurance coverage for me as I am expected and encouraged to
obtain my own medical or health insurance coverage.
I do hereby release and forever discharge the organizer from any claim which arises or may hereafter
arise on account of any first aid, treatment or service rendered in connection with my participation in
13th National Chem-E Car Competition 2018.

Additionally, I understand that I may be photographed, filmed, videotaped or audiotape during 13th
National Chem-E Car Competition 2018 and its affiliates (sponsors, event partners and other so
determined) will own all or part of any such film, tape or recording and use it for any purpose without
providing remuneration or seeking permission.
I have read and understood this waiver.

……………………………. …………………………….
Name: Name:
IC Number: IC Number:
Date: Date:

……………………………. …………………………….
Name: Name:
IC Number: IC Number:
Date: Date:
APPENDIX A
RISK ASSESSMENT FORM

University Name:
Group Name:

Risk Identified Controls in place (High, Medium ,Low)

APPENDIX B
CHEMICAL HAZARD RISK PHRASE FORM (Refer Safety Data Sheet)

Group
Risk Phrase/Hazard Statement Safety Phrase/Precautionary Statement
Name:
Name CAS No. Description Description