DCU SCHOOL OF MECHANICAL AND MANUFACTURING ENGINEERING SAFETY DECLARATION FORM FOR RESEARCH WORKERS

THIS FORM MUST BE COMPLETED BY ALL RESEARCH WORKERS (POSTGRADUATES, POSTDOCTORAL, AND VISITING WORKERS) BEFORE WORK COMMENCES. THIS FORM IS ALSO USED AS PART OF SAFETY INDUCTION FOR ALL NEW RESEARCHERS IN THE SCHOOL.

This form should be completed jointly by postgraduate, postdoctoral or visiting research worker, and

the appropriate academic research supervisor. This form must then be reviewed and countersigned by

the School Safety Adviser. The form will be held by the School Safety Advisor.

  • Equipment used by a research worker during the course of his/her research must be risk assessed.
  • Experimental procedures that a research worker will be carrying out during the course of his/her research work must be risk assessed.
  • Guidance for undertaking a Risk Assessment is given in the School Safety Statement. If in doubt please contact the School Safety Adviser.

Name of research Project Supervisor:

Name of research worker*:

Lab/ Room No.:

*Status: postgraduate, postdoctoral or visitor (delete as appropriate)

______

Project title/Research area ......

Give a brief description of the type of research work to be undertaken.

By signing this safety declaration form, I understand the following:

  • I have read the DCU School of Mechanical and Manufacturing Engineering Safety Induction Information Leaflet for postgraduate and postdoctoral researchers. I am aware of the School of Mechanical and Manufacturing Engineering Safety Statement.
  • I will seek advice from my research colleagues, my project supervisor, school safety advisor, or technical staff where appropriate, if I am in doubt about any safety matter relating to my work.
  • I have a duty of care to comply with University and School safety procedures at all times during the course of my research.
  • I will carry out Risk Assessments and develop Standard Operating Proceduresas required during the course of my work within the School of Mechanical and Manufacturing Engineering, Dublin City University.
  • If my work requires the use of chemicals or biomaterials I will consult the relevant Material safety Data Sheets (MSDS) and carry out any relevant COSHH or biohazard assessments. In addition I will become familiar with the relevant University policies for correct disposal of chemicals and biomaterials.
  • If I intend to work Outside hours, I will do so as per the UniversityPolicy for Lone /Out of hours work, see

Signature of the research worker......

Date:

For the project supervisor:

I have discussed in detail the nature of the research work with the research worker. I am fully aware that

the research worker will consult with me on matters pertaining to his/her safety at all times. I will also

consult with the School Safety Adviser, or technical staff where appropriate on matters pertaining to my research

worker’s personal safety.

Signature of project supervisor…………………………………………

Date:

For the School Safety Adviser (S.S.A.)

I reviewed the above Safety Declaration Form for the research worker and, on behalf of the Head of

School, allow him/her to start research work in the School of Mechanical and Manufacturing Engineering DCU

Signature of the School Safety Advisor...... ……

Date:

Safety Questionnaire- This questionnaire must be filled out as part of your safety declaration form.

What is your main priority in the event of discovering a fire or hearing a fire alarm sound?

Ans:

What is the basic personal protective equipment you are obliged to wear when working in a research

laboratory?

Ans:

In an emergency, who should you contact inside normal working hours?

Ans:

In an emergency, who should you contact outside normal working hours? Detail phone number.

Ans:

What School Safety form must be filled out when you are finishing up research work in the School and you wish to

graduate?

Ans:

What form must be filled out when you wish to order a new chemical?

Ans:

What government act enshrines safety in the workplace?

Ans:

Who has ultimate responsibility for safety in the School of Mechanical and Manufacturing?

Ans:

Who can you seek advice from on safety matters in the School of Mechanical and Manufacturing Engineering?

Ans: