Safety Questionnaire

Current Safety Questionnaire

SEAS/Physics/EPS Safety Questionnaire

This questionnaire has been developed for all SEAS/Physics/EPS faculty, staff and students. Obtaining this information enables us to ascertain how we can best assist you in the safe pursuit of your research goals.

Name:
Address:
Phone:
Email:
Supervisor/Advisor:
  1. If you have ever worked in a research lab, please elaborate on your experience.
  2. Have you ever used compressed gases and/or high pressure gas fittings?
    If so, what type(s)?
  3. Have you ever had any experience in glassblowing?
    If so, please elaborate.
  4. Have you ever had any formal training in electrical safety?
  5. Have you ever used:
    • An Oscilloscope?
    • Low Voltage Power Supply?
    • High Voltage Power Supply?
    • Other Electronic Test Equipment?
    • Soldering Iron?
  6. Have you ever used:
    • Dry Ice?
    • LN2?
    • LHe?
  7. Have you ever used power hand tools?
    If so, please list.
  8. Have you ever used:
    • Sheet Metal tools?
    • Milling Machine?
    • Lathe?
    • Drill Press?
    • Band Saw?
    • Grinder?

    If yes to any of the above, please elaborate.
  9. Have you ever used radioactive sources?
  10. Have you ever worked with hazardous biological materials?
  11. Have you ever been trained in the appropriate clean-up procedures in the event of a spill (radioactive or biological)?
  12. Have you ever used any type of a laser system?
    If so, please specify type, classification, and application:
  13. Have you ever used solvents such as acetone, chloroethane, alcohol benzene, and trichlorethylene?
    If so, under what conditions and applications?
  14. Please summarize your current work tasks and/or research aspirations with a focus on what types of safety hazards might be present and what safety training might be required.

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Send comments or suggestions to solomon@huarp.harvard.edu Last Updated: Thu Apr 10 16:02:33 2008
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