THE CONESTOGA COLLEGE INSTITUTE OF TECHNOLOGY

AND ADVANCED LEARNING

ACKNOWLEDGEMENT OF SAFETY TRAINING AND RESPONSIBILITIES

As a student in CHEM8010, I understand that certain risks and dangers are inherent in this
program/course and, in particular, in the shop/lab areas.

I acknowledge that I have completed and understood the safety training for this program.

I agree to follow safety procedures as outlined by college staff and to question those I do not fully
understand.

I further acknowledge that my personal safety is primarily my responsibility and I am fully

accountable for my actions.

I will consult with college staff in situations in which I am unsure of appropriate safety practices
or considerations.

If I observe a potential hazard, or any situation which I perceive to be unsafe, I will bring it to the
attention of a college employee.

I will not use or operate equipment/machinery that I have not been trained on, or am not familiar
with the safe operation of.

STUDENT NAME (PLEASE PRINT)

SIGNATURE DATE

8/27/2019