Fillable Risk Assessment Form (3) (Microsoft)

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Risk Assessment Form (3) (Microsoft)

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Page 38 International Rules: Guidelines for Science and Engineering Fairs 2021–2022, societyforscience.org/ISEF
Risk Assessment Form (3)
Must be completed before experimentation. May be required for projects involving Hazardous Chemicals,
Materials or Devices or Potentially Hazardous Biological Agents; recommended for all projects.
Student’s Name(s)
Title of Project
To be completed by the Student Researcher(s) in collaboration with Designated Supervisor/Qualiied
Scientist: (All questions must be answered; additional page(s) may be attached.)
1. Identify and assess the risks and hazards involved in this project.
2. a) List all hazardous chemicals, activities or devices to be used; b) identify and list all microorganisms to be used that
are exempt from pre-approval (see Potentially Hazardous Biological Agent rules).
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ied 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 the International Rules, including the science fair ethics statement and will provide
direct supervision.
Designated Supervisor’s Printed Name Signature Date of Review (mm/dd/yy)
Experience/Training as relates to the student’s area of research
Position/Institution Phone or email contact information
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Risk Assessment Form (3) (Microsoft)

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Completed 3 August 2021

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