Name________________________ Phone #_________ Dana ID_________ Student ID______________ Date_____

Course #:  CHM  130L   151L   152L   230L   235L   238L   320L  338L   425L   442L   450L   460L  Section Letter___

                                                (Circle one of the above course numbers)

Current or Last Math Course Taken (college or high school)_______________________  Month/Year Taken_______

The following assignment/exercise must be completed and handed in to your TA before leaving lab today. You

 may lose your place in lab and would have to drop the lab course if your TA doesn't get this sheet.

1. What personal protective safety device is absolutely mandatory when corrosive liquids are in use?__________ Why?


2. In the space below draw a diagram of your laboratory room which identifies the location of (attach paper if you wish);

a) all lab benches and ID your work area   b) eye washes and eye wash station   c) safety shower   d) fire extinguisher(s)

e) fume hood(s)     f) exits    g) any obstacles    h) reagents    i) hazardous waste bottles    j) first aid kit    k) lost & found

 l) right to know station with chemical hygiene plan and MSDS/SDS    m) spill kit     n) broken glass bucket









And in the hallway outside your lab;

l) fire alarm pull stations      m) AED     n) phone      o) exits      p) fire extinguisher (s)    q) shower room     r) stockroom






3.  Close your eyes and try to face the safety shower.  Are you facing in the right direction? ___________ 

Could you locate the safety shower with your eyes closed?_______  What type of situations would this simulate?



4.  What are the four main types of chemical hazards and their indicator colors?


5.  What is the proper action if a corrosive chemical gets on your hand?



                In your eye?



                All over your leg?



6.  Describe the chemical hazards of a chemical with a hazard code of 1024:                                     



7.    How do you dispose of broken glass?

8.    Number to contact campus security on house phone in hallway. ___________ On your cell phone_____________

9.  Where should your lab stool be whenever you are not sitting in it? ______________________________________

10. What is the drop deadline?________  What is the withdrawal deadline?__________

11. Calculator Check:  Adding 1.45347821   +  1.00000000 should  =  2.45347821  ( if not see your TA).

12. Health Concerns (circle or fill in blank please, please discuss any confidential information with your TA or instructor)

   a. Are you colorblind?    yes   no              d. List any allergic reactions:___________________________________.

   b. Do you wear contacts?    yes   no        e. You or family reactions to:         Latex           Nitrile         PVC

   c. List any respiratory problems:_____________________ List other medical conditions we should be aware of below: