  {"id":2031,"date":"2020-08-12T10:53:50","date_gmt":"2020-08-12T15:53:50","guid":{"rendered":"https:\/\/uwm.edu\/bms-labs\/?page_id=2031"},"modified":"2024-07-19T10:05:24","modified_gmt":"2024-07-19T15:05:24","slug":"safety-agreement-form","status":"publish","type":"page","link":"https:\/\/uwm.edu\/bms-labs\/laboratory-forms\/safety-agreement-form\/","title":{"rendered":"Safety Agreement Form"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-4117 size-full\" src=\"https:\/\/uwm.edu\/bms-labs\/wp-content\/uploads\/sites\/361\/2024\/06\/BMS-Program.jpg\" alt=\"\" width=\"334\" height=\"168\" srcset=\"https:\/\/uwm.edu\/bms-labs\/wp-content\/uploads\/sites\/361\/2024\/06\/BMS-Program.jpg 334w, https:\/\/uwm.edu\/bms-labs\/wp-content\/uploads\/sites\/361\/2024\/06\/BMS-Program-300x151.jpg 300w\" sizes=\"auto, (max-width: 334px) 100vw, 334px\" \/><\/p>\n<p><strong>.<\/strong><\/p>\n<p><strong>.<\/strong><\/p>\n<p><strong>\u00a0<\/strong><\/p>\n<p style=\"text-align: center\">Although there are certain hazards present in the medical laboratory, it is possible to make the laboratory a safe working environment. Each laboratory worker must agree to observe all safety rules posted or un-posted which the instructor requires. No set of rules can cover all the hazards that may be present. However, several general rules are listed in the General Laboratory Safety Rules in your lab manual. Please fill out the following questions after reading over the General Laboratory Safety Rules below:<\/p>\n<h1 style=\"text-align: center\"><a name=\"_Toc207383886\"><\/a><a name=\"_Toc111958559\"><\/a>General Laboratory Safety Rules<\/h1>\n<ol>\n<li>Eating, drinking, gum chewing, applying makeup, and handling of cell phones is <strong>NOT<\/strong> allowed in the laboratory. Food and beverages may not be brought into the laboratory.<\/li>\n<li>Dress appropriately when working in the lab:\n<ol>\n<li>Avoid wearing chains, bracelets, or other loose hanging jewelry.<\/li>\n<li>Tie long hair up or back to avoid contact with hazards, for example, chemicals, equipment, or organisms.<\/li>\n<li>Closed toe shoes must be worn at all times<\/li>\n<\/ol>\n<\/li>\n<li>Use appropriate Personal Protective Equipment (PPE)\n<ol>\n<li>Wear a fluid resistant laboratory coat. Remove your lab coat before leaving the laboratory or adjacent hallways.<\/li>\n<li>Wear gloves when handling blood, body fluids, or hazardous chemicals.<\/li>\n<li>Wear eye protection or use a counter-top acrylic shield when working with strong chemicals or anytime splashes are likely to occur.<\/li>\n<\/ol>\n<\/li>\n<li>Wash hands after removing gloves, when completing laboratory procedures, before leaving the lab, &amp; at any other time necessary.<\/li>\n<li>Use Standard Precautions when handling patient &amp; biological specimens, including blood &amp; diagnostic products made from human blood.<\/li>\n<li>Maintain your work area\n<ol>\n<li>Clean &amp; disinfect work area before &amp; after laboratory procedures &amp; any other time<\/li>\n<li>Keep your work area neat and organized.<\/li>\n<li>Wipe up spills promptly &amp; use the appropriate clean up procedure for the type of spill.<\/li>\n<\/ol>\n<\/li>\n<li>Discard all contaminated materials into an appropriate, labeled biohazard container.\n<ol>\n<li>A special rigid, puncture-proof container must be used for disposal of sharps such as needles &amp; lancets.<\/li>\n<li>Contaminated items that would puncture a biohazard bag are disposed of in the biohazard boxes on the counter-tops. (Glass slides, Glass pipets, broken contaminated glass)<\/li>\n<li>All other contaminated waste requiring biohazard disposal is disposed of in the biohazard bags on the counter-tops<\/li>\n<\/ol>\n<\/li>\n<li>Discard any uncontaminated broken glassware into cardboard containers designated for broken glass.\n<ol>\n<li>Do not use bare hands to pick up broken glass; use a broom or brush &amp; dustpan.<\/li>\n<\/ol>\n<\/li>\n<li>When using laboratory equipment\n<ol>\n<li>Follow the manufacturer and instructor\u2019s directions.<\/li>\n<li>Report any broken or frayed cords, exposed electrical wires, or other damage to equipment.<\/li>\n<\/ol>\n<\/li>\n<li>Discuss any safety concerns or questions you may have with your instructor.<\/li>\n<li>Report any accident to the instructor immediately. Fill out an accident report form.<\/li>\n<\/ol>\n<p><u>Reference:<\/u>\u00a0\u00a0\u00a0\u00a0 <em>Basic Medical Laboratory Techniques<\/em>, 4th. ed., 2000<\/p>\n<p>Norman Walters, Barbara Estridge, Anna Reynolds, Delmar publishers.<\/p>\n<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_unknown gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_86' style='display:none'>\n                        <div class='gform_heading'>\n                            <h3 class=\"gform_title\">Safety Agreement Form<\/h3>\n                            <p class='gform_description'><\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_86'  action='\/bms-labs\/wp-json\/wp\/v2\/pages\/2031' data-formid='86' novalidate><div class='gf_invisible ginput_recaptchav3' data-sitekey='6Let4LkmAAAAAMDytJZITec55NB97k2BiShMXqPE' data-tabindex='0'><input id=\"input_befa3a9267c2af013b141064915975db\" class=\"gfield_recaptcha_response\" type=\"hidden\" name=\"input_befa3a9267c2af013b141064915975db\" value=\"\"\/><\/div>\n                        <div class='gform-body gform_body'><ul id='gform_fields_86' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_86_1\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_1'>I have read the General Laboratory Safety Rules and understand that I can ask my instructor or TA if I have any questions relating to it.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_86_1' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_86_2\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_2'>I understand that while performing procedures &amp; techniques in the clinical laboratory, I may be exposed to blood &amp; body fluids that have the potential for transmitting infectious agents such as hepatitis &amp; HIV (human immunodeficiency) viruses.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_2' id='input_86_2' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_86_3\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_3'>I have been instructed in the proper use of protective measures &amp; universal (or standard) precautions when handling blood and body fluid specimens.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_86_3' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_86_4\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_4'>I agree to follow all safety rules &amp; regulations as required by the instructor, including the rules listed in the laboratory manual.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_4' id='input_86_4' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_86_5\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_5'>I agree to come to class prepared &amp; ready to practice good safety techniques in the lab, to routinely use appropriate barrier protection to prevent skin &amp; mucous membrane exposure while working with blood &amp; body fluids, and to use appropriate protective equipment &amp; practice universal precautions when handling biological specimens.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_5' id='input_86_5' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Yes' >Yes<\/option><\/select><\/div><\/li><li id=\"field_86_6\" class=\"gfield gfield--type-name gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_86_6'>\n                            \n                            <span id='input_86_6_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.3' id='input_86_6_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_86_6_3' class='gform-field-label gform-field-label--type-sub '>First<\/label>\n                                                <\/span>\n                            \n                            <span id='input_86_6_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_6.6' id='input_86_6_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_86_6_6' class='gform-field-label gform-field-label--type-sub '>Last<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/li><li id=\"field_86_7\" class=\"gfield gfield--type-email gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_7'>51ÁÔÆæ Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_7' id='input_86_7' type='email' value='' class='medium'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_86_9\" class=\"gfield gfield--type-select gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_9'>Instructor of course<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_9' id='input_86_9' class='medium gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' ><\/option><option value='Shahla Anders' >Shahla Anders<\/option><option value='Cindy Brown' >Cindy Brown<\/option><option value='Brad De Pons' >Brad De Pons<\/option><option value='Dr. Jennifer Doll' >Dr. Jennifer Doll<\/option><option value='Dr. Janis Eells' >Dr. Janis Eells<\/option><option value='Dr. Elizabeth Liedhegner' >Dr. Elizabeth Liedhegner<\/option><option value='Dr. Dean Nardelli' >Dr. Dean Nardelli<\/option><option value='Dr. Troy Skwor' >Dr. Troy Skwor<\/option><option value='Sue Stalewski' >Sue Stalewski<\/option><option value='Other (please specify below)' >Other (please specify below)<\/option><\/select><\/div><\/li><li id=\"field_86_10\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_10'>Untitled<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_10' id='input_86_10' type='text' value='' class='medium'    placeholder='Other' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_86_8\" class=\"gfield gfield--type-text gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_86_8'>Please type your name in the box below.  Your typed name indicates agreement with the above statements.  Agreement is valid for 1 year following date of submission.  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Each laboratory worker must agree to observe all safety rules posted or un-posted which the instructor&#8230; <a class=\"read-more\" href=\"https:\/\/uwm.edu\/bms-labs\/laboratory-forms\/safety-agreement-form\/\">Read More<\/a><\/p>\n","protected":false},"author":3174,"featured_media":0,"parent":1409,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":"","uwm_wg_additional_authors":[]},"class_list":["post-2031","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v27.3 (Yoast SEO v27.3) - https:\/\/yoast.com\/product\/yoast-seo-premium-wordpress\/ -->\n<title>Safety Agreement Form - Biomedical Sciences Labs<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/uwm.edu\/bms-labs\/laboratory-forms\/safety-agreement-form\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Safety Agreement Form\" \/>\n<meta property=\"og:description\" content=\". . \u00a0 Although there are certain hazards present in the medical laboratory, it is possible to make the laboratory a safe working environment. 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