Fillable SMU Graduate Research Hazards Assessment form 2010

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SMU Graduate Research Hazards Assessment form 2010

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Graduate Research Hazards Assessment
Updated: May 2010
University personnel in positions of supervision/responsibility of graduate students have ethical and legal
responsibilities for the students’ safety in regard to their approved research activities. The purpose of this form is
(1) to bring to the attention any possible hazards that a graduate student may be exposed in carrying out their
proposed research activities, (2) to provide an initial risk assessment, and (3) propose an initial risk management
strategy. This form should be seen as the initiation of the management of the risk associated with hazards in
graduate research, not the complete process. As hazards and risks associated with research activities change, it
is students’ responsibility to bring these to the attention of their Supervisors.
This form should be completed as soon as possible as the thesis research is being developed/designed and
updated/resubmitted if the hazards/risks change.
While graduate students are individuals of the age of majority with the right of self-determination, without
appropriate assessment and oversight of the graduate students’ abilities to manage the risks associated with
doing research in hazardous settings, the Supervisors and the University may be in legally culpable in the case of
death or bodily harm to the graduate students and they are found to have been negligent. With this in mind,
Supervisors reserve the right to refuse approval of thesis research proposals when the risks to the
graduate students are assessed to be greater than can be reasonably managed. Similarly, the University
reserves the right to override the approval of thesis research and/or to recall graduate students from the
field when the risks (anticipated or newly arising) to the graduate students are assessed to be greater
than can be reasonably managed.
Procedures:
The student prepares the thesis research proposal and completes Sections I to VII of the Graduate
Research Hazards Assessment form, as applicable.
When the research proposal is discussed with the Supervisor/Supervisory Committee, the information
provided by the student in Graduate Research Hazards Assessment form should also be considered.
If the Supervisor/Supervisory Committee cannot sign the certification as detailed in Section VIII, the
Program Coordinator should be notified and normally the student will revise his/her proposal and/or the
information within the Graduate Research Hazards Assessment according to the recommendations of the
Supervisor/Supervisory Committee.
Only once the Supervisor/Supervisory Committee is satisfied that any risks associated with the thesis
research are manageable, should they sign the certification in Section VIII.
The Graduate Program Coordinator will make his/her comments and forward the Form to the Dean of the
FGSR.
The graduate student can only move forward on his/her research until he/she has notification of the
approval of the Graduate Research Hazards Assessment from the Dean.
If the hazards or risks associated with the proposed research changes, the student must notify the
Supervisor/Supervisory Committee as soon as possible. The Supervisor/Supervisory Committee will
notify the Program Coordinator and the Dean of the FGSR as applicable/needed.
*Vetting of your GRHA by FGSR normally takes a minimum of 10 working days.
Graduate Research Hazards Assessment Form
FGSR, Saint Mary’s University
Section I – Student Identification
Name:
Student #:
Graduate
Program:
Supervisor’s
name:
Local
Address:
E-mail:
Phone:
□This is an original notification, or
□This is an update on an original notification that was dated
Thesis research title:
Brief description of the thesis research:
Section II – Hazard Assessment Declaration
Note: “Hazards” are defined here as substances, materials, equipment, or situations that may result in
risks to the graduate student beyond the normal risks that the average Canadian university student is
exposed in carrying out their normal daily activities. For example, using normal means of commuting to
the University to carry out the research would not be defined as a hazard here. Road-testing an
experimental bicycle prototype in commuter traffic would be defined as a hazard.
Please check one of the following:
□ A. My thesis research will not involve any hazards (go to Section VII).
□ B. My thesis research will involve hazards (go to Section III)
Section III – Identification of Hazards
My thesis research will be carried out:
□ A. Only on campus
□ B. On and off campus
My research will involve the following hazardous substances (check off as many of the following that
apply):
□ A. Biohazards (e.g. infectious materials)
□ B. Dangerous chemicals (corrosive, carcinogenic, explosive, inflammable,
toxins)
□ C. Substances under high pressure
□ D. Radio-active materials
□ E. Other (list details/examples):
My research will involve the following potentially hazardous situations (check off as many of the
following that apply):
□ A. International travel* (list proposed countries):
□ B. Field work in isolated settings or hazardous environments (e.g. unpopulated rural
sites; wilderness; marine environments; industrial settings; dangerous urban
settings)
□ C. Use of hazardous equipment (e.g. chain saws, tractors)
□ D. Interviews/interactions with criminal elements or other potentially dangerous
individuals (list details/examples):
□ E. Other potentially hazardous situations (list details/examples):
*Students engaged in international travel should contact Saint Mary’s International Activities Office (420-5177).
Section IV – Personal Risk Assessment
Based upon the Hazards identified in Section III, please provide details on the hazards and explain in
your own words your assessment of the level and nature of the risk associated with the hazard(s) (use
an additional page if necessary):
Examples:
(1) I will be using perchloric acid in my experiments. Perchloric acid is extremely corrosive, and when
mixed with organic substances, can be explosive. Crystalline perchloric acid is extremely dangerous
and can explode at elevated temperatures . . .
(2) I propose to do my research in Egypt in the summer of 2007. Although armed hostilities have not
taken place there for some time, the volatile situation in the middle-east region means one should be
aware of all possibilities. There has also been several isolated bomb attacks of tourism sites in the
recent past. The most dangerous settings are in the border regions with Gaza and in the tourism
region along the Red Sea. . .
Section V – Proposed Risk Management Strategy
Based upon the Hazards and Risk Assessment identified in Sections III and IV, please explain in your
own words your previous experience in handling such risks and how you would propose to manage the
risk associated with the hazard(s) (use an additional page if necessary):
Examples:
(1) I am familiar with normal laboratory practices from working in a laboratory as a summer lab
assistant. However, I have never handled perchloric acid before. I will receive WHMIS training in my
Department and specific training on the safe handling and use of perchloric acid by my Supervisor.
MSDS data sheets on perchloric acid exist in the lab. Perchloric acid will only be used within
fumehoods specially designed to handle such corrosive/explosive substance, located in Room X and Y
in the Science Building. We have a practice in our lab that if anyone is using perchloric acid, there
must be at least one other person present on the floor at all times. . .
(2) I have travelled extensively in western Europe and throughout North America as a tourist. However,
I have never travelled in the Middle East our carried out research abroad. As per procedures at Saint
Mary’s, I will attend a pre-departure meeting at the International Activities office on the risk associated
with traveling in the Middle East and n Egypt in particular. My research will be taking place in Cairo and
I will not be traveling near the border with Gaza or in tourism regions along the Red Sea. Upon arrival
in Egypt, I will register with the Canadian Embassy. . .
Section VI – Certification by the Graduate Student
I certify that I have completed this Graduate Research Hazards Assessment form to the best of my
ability and I have not knowingly withheld any information on my understanding of the hazards and risks
associated with my proposed research.
I recognize that if the risk associated with my proposed research is assessed to be unmanageable by
my thesis Supervisor(s) or at higher levels in the University, I will be required to modify the proposed
research in a manner that will satisfy the concerns of my Supervisor(s)/the University.
Student’s signature
Date
Section VII – Assessment by the Supervisor/Supervisory Committee
I/We have reviewed the student’s research proposal and have discussed with the student the
information provided in this form. I/We have found that the hazards are well identified, that the risks are
well assessed, and that the risk management strategy will enable the risks to be reasonably well
managed.
If for any reason, Supervisor(s) are not in agreement with the above statement, they should withhold
their signature(s) and bring the issue to the attention of the Graduate Program Coordinator.
Alternatives will have to be explored so that any risks associated with the proposed research can be
manageable.
Once the form is signed, a copy should be forwarded to the Program Coordinator/Director.
Supervisor’s name
Signature
Date
Supervisory Committee Members:
Name
Signature
Date
Name
Signature
Date
Name
Signature
Date
click to sign
signature
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Section VIII – for Graduate Program Coordinator/Director’s Office use only*
Date form received
Signature
Comments:
*Graduate Program Coordinator/Director should keep a copy of the form for their files and forward original to the
FGSR Office.
Section IX – for Dean, FGSR Office use only
+
Date form received
Signature
Comments:
+
Once all signatures are obtained, copies should be sent to the graduate student, the Supervisor, and the
Program Coordinator/Director. The original will be held in the student’s file in the FGSR Office.
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