8/19/2019 LAB FORM 1rev1 Chemical Engineering Laboratory Use Permit

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LAB FORM 1

Chemical Engineering Laboratory Use PermitDepartment of Chemical Engineering, University of the Philippines Diliman

This form is to be completed in 2 copies. Regular working hours are 8:00 AM – 5:00 PM on weekdays only.Work beyond these hours requires the presence of a supervisor, as defined in the Policies on the Use ofthe Chemical Engineering Laboratory, and an approved LAB FORM 2. This form is to be submitted at least3 working days prior to the start of work. Refer to equipment calendar for scheduling of equipment use.Students without approved permits are prohibited from working in the Chemical EngineeringLaboratory.

School Year and Semester:

Date of Application:

Name(s) and Contact Number:

Degree and Program of Study:

Title of Experiment:

Equipment to be Used:

Hazardous Chemicals Involved:

Location of Experiment:

Adviser’s Endorsement: (name and signature)

HSE Officer’s Endorsement:(name and signature)

_________________________ _________________________Laboratory Head’s Approval Laboratory Manager’s Approval*

(name and signature) (name and signature) * If working in the pilot plant

For Admin Use Only:[ ] Passed the online LUOSS Exam (Date: _________________) Verified by: ____________ Attachments for first-time researchers (to be renewed/updated every semester): [ ] LAB FORM 3: Risk Assessment Form[ ] LAB FORM 4: Waste Management Plan[ ] Photocopy of Insurance Policy

[ ] Waiver and Release from Liability FormLast revised: July 02, 2015

8/19/2019 LAB FORM 1rev1 Chemical Engineering Laboratory Use Permit

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