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SAFETY COMPLIANCE FORM
THIS FORM MUST BE COMPLETED BY ALL USERS OF INRF and BiON
To ensure safety for all users of the INRF and BiON Cleanroom Facilities, we require that all users complete
safety training which includes the following steps listed below. The required safety documents and training
contain important information on potential hazards that can exist in a cleanroom setting and how to limit
your exposure and risk.
1.) Read & Study the following documentation (found on INRF Website at:
http://www.inrf.uci.edu/?page_id=233, hard copies are also available in the INRF Office):
a. INRF Chemical Hygiene Plan
b. INRF Laboratory Safety Manual
c. MSDS Literature
2.) Attend:
a. New User Orientation
b. UCI EH&S Safety Training
i. Labatory Core Safety
ii. Hazardous Waste
After completion, User is encouraged to ask INRF Staff members questions to ensure comprehension of
safety documentation. This form is required in order to become a user of our cleanroom facilities. Please sign
this form and submit with EH&S Safety Training certification to INRF Staff.
User Acknowledgement and Agreement:
I acknowledge that I have read and understand the INRF Safety Documentation listed above and have
attended the Orientation Presentation and completed the EH&S training. I am aware of potential hazards
that exist in the lab and have been informed of the necessary precautions to take to limit risk. This includes
(but is not limited to) exposure to a number of very toxic materials, such as hydrogen, dichlorosilane,
ammonia gases, solvents and acids, and pieces of high voltage equipment. For my personal safety, I agree to
wear a pair of safety glasses or chemical splash goggles which conform to the ANSIZ87.1-1989 standard at all
times when inside the INRF and/or BiON clean room areas. In addition, I agree to follow all INRF and
BiON safety polices and equipment operating procedures.
I understand that violation of safety policies and procedures will lead to the following disciplinary
action:
1. Verbal warning to the violator by INRF and/or BiON staff member
2. Letter to the violator’s advisor or supervisor
3. Suspension of access to the INRF and/or BiON for a period of one month
4. Permanent loss of access privileges
USER Name:____________________________________Title:_______________________________
Signature: ___________________________________________________Date: _________________