Page 36 International Rules: Guidelines for Science and Engineering Fairs 2018 2019,
Risk Assessment Form (3)
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/Quali ed
(All questions must be answered; additional page(s) may be attached.)
1. List all hazardous chemicals, activities, or devices that will be used; identify microorganisms exempt from pre-approval (see
Potentially Hazardous Biological Agent rules).
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 Quali 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/Project Summary 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
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