5th Annual Kent County Science Fair Application Form, Checklist For Adult Sponsor, Student Checklist Etc Page 10

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Risk Assessment Form (3)
Required for projects using hazardous chemicals, activities or devices and microorganisms exempt from
pre-approval. Must be completed before experimentation.
Student’s Name(s)
Title of Project
To be completed by the Student Researcher(s) in collaboration with Designated Supervisor/Qualifi ed
Scientist:
(All questions must be answered; additional page(s) may be attached.)
1. List/identify microorganisms exempt from pre-approval
Potentially Hazardous Biological Agent rules),
(see
and all hazardous chemicals, activities, or devices that will be used.
2. Identify and assess the risks involved in this project.
3. Describe the safety precautions and procedures that will be used to reduce the risks.
4. Describe the disposal procedures that will be used (when applicable).
5. List the source(s) of safety information.
To be completed and signed by the Designated Supervisor (or Qualifi ed Scientist, when applicable):
I agree with the risk assessment and safety precautions and procedures described above. I certify that I have reviewed the
Research Plan and will provide direct supervision.
Designated Supervisor’s Printed Name
Signature
Date of Review
(mm/dd/yy)
Position & Institution
Phone or email contact information
Experience/Training as relates to the student’s area of research
Page 34
International Rules: Guidelines for Science and Engineering Fairs 2014–2015,

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