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LAB FORM 1

Chemical Engineering Laboratory Use Permit


Department of Chemical Engineering, University of the Philippines Diliman
This form is to be completed in 2 copies. Regular working hours are 8:00 AM 5:00 PM on weekdays only.
Work beyond these hours requires the presence of a supervisor, as defined in the Policies on the Use of
the Chemical Engineering Laboratory, and an approved LAB FORM 2. This form is to be submitted at least
3 working days prior to the start of work. Refer to equipment calendar for scheduling of equipment use.
Students without approved permits are prohibited from working in the Chemical Engineering
Laboratory.
School Year and Semester:
Date of Application:
Name(s) and Contact Number:

Degree and Program of Study:


Title of Experiment:

Equipment to be Used:

Hazardous Chemicals Involved:

Location of Experiment:
Advisers Endorsement:
(name and signature)

HSE Officers Endorsement:


(name and signature)

_________________________
Laboratory Heads Approval

_________________________
Laboratory Managers Approval*

(name and signature)

(name and signature)

* If working in the pilot plant

For Admin Use Only:


[ ] Passed the online LUOSS Exam (Date: _________________)
Verified by: ____________
Attachments for first-time researchers (to be renewed/updated every semester):
[ ] LAB FORM 3: Risk Assessment Form
[ ] LAB FORM 4: Waste Management Plan
[ ] Photocopy of Insurance Policy
[ ] Waiver and Release from Liability Form
Last revised: July 02, 2015

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