ACKNOWLEDGEMENT FORM

• THIS DOCUMENT AFFECTS YOUR LEGAL RIGHTS. YOU MUST READ AND UNDERSTAND IT BEFORE
SUBMISSION OR SIGNING.
• THIS FORM IS AN ACCEPTANCE OF RESPONSIBILITY AND ACKNOWLEDGES AN UNDERSTANDING
OF RISKS ASSOCIATED WITH THE PRACTICAL LESSONS/WORKSHOPS/OCT/OJT.
• SIGNING THE DOCUMENT MEANS:
ü YOU HAVE COMPLETED THE LAB SAFETY TRAINING
ü YOU HOLD THE FULL RESPONSIBILITY TO KEEP YOURSELF, OTHERS, EQUIPMENT
ANDENVIRONMENT SAFE AND SECURE

Academic Year 2023-24 Semester Spring Semester

Course Course
Department ASD PHYS1012 Physics Lab I
Code Name
Instructor
Lab Name PHYS1 Location P-C-G Doaa Al Yafeai CRN 2070
Name

☐ I acknowledge that I am aware of the Lab Safety Rules

☐ I agree to fully comply with rules as my compliance ensures my own safety and the safety of
other students when participating in the activities of the lab.

☐ I acknowledge that there are certain risks, hazards and dangers in this lab, and I am aware of
these hazards.

☐ I acknowledge that I have received the lab safety training and learnt how to deal with /avoid the
risks and hazards in this lab

☐ I hereby accept all responsibility and liability for any injuries or damage that may result from
being in the lab, which shall include, but not be limited to, any injuries or damage resulting
fromactivities at the lab.

Student Adpoly ID: M00008477

Student Name: Rashed abdulla alblooshi

Student Signature: …………………………………………..

Date: 22-1-2024