Guidelines for care & Use of Dry Solvent Stills [Example]

1. Certification of Safety Training Form for Graduate Students, Post-Graduates,
and Summer School Undergraduate Research Students
CHEMISTRY DEPARTMENT CERTIFICATION OF SAFETY TRAINING
FOR GRADUATE STUDENTS, POST-DOCTORATES,
AND SUMMER SCHOOL UNDERGRADUATE RESEARCH STUDENTS
I certify that the following Graduate Student or Post-Doctorate has seen the Safety Film and
received the instruction to read the Chemical Hygiene Plan and Safety Manual for Salem Hall (with special
emphasis on the Bowman-Gray School of Medicine‟s “The Health Hazards of Some Common Chemicals”
and “Procedures for Handling Hazardous Chemical Waste”),
Or
That the Summer School Research Undergraduate student listed at the bottom of this form has
seen the Safety Film and received the normal Departmental Safety Handouts (with special emphasis on the
Bowman-Gray School of Medicine‟s “The Health Hazards of Some Common Chemicals” and “Procedures
for Handling Hazardous Chemical Waste”).
Print name of Witnessing WFU Chemistry Professor
Signature Date
I have seen the Safety Film, received the Departmental Safety Handouts, and read the Chemistry
Department‟s Chemical Hygiene Plan and Safety Manual, including the “Procedures for Handling
Hazardous Chemical Waste”, and “The Health Hazards of Some Common Chemicals” and agree to abide
by the rules and regulations stated therein.
Print Graduate Student or Post Doc Name
Signature Date
I have read the Chemistry Department‟s Safety Handouts, read and signed the Basic Safety Rules for All
Undergraduate Laboratories, seen the Safety Film, and read the “Procedures for Handling Hazardous
Chemical Waste” and “The Health Hazards of some Common Chemicals”, and agree to abide by the rules
and regulations stated therein.
Undergraduate Research Student Name
Signature Date
169