Lab Safety Education
- Safety Data Sheet (SDS) Access
- Emergency Response Form
- Emergency Evacuation - NSB
- Emergency Evacuation - York Hall
Lab workers may (at their own discretion) use this form to record information to be used in case of emergencies. Print this page, fill in any parts that concern youor your conditions, and carry it with you.
Lab students: please fold the form and tape it INSIDE THE BACK COVER OF YOUR LAB NOTEBOOK. Revise, replace or discard the form as needed. If a student is ill/injured and cannot respond, this information will be provided to emergency responders (paramedics/hospital personnel).
STUDENT NAME ___________________________________ Address ___________________________________________ ___________________________________________________ Phone _____________________________________________ UCSD ID # _________________________________________ |
EMERGENCY CONTACT NAME |
MEDICAL INFORMATION:
(List ALL allergies (food, medication, plants, bites, etc.), ongoing medical concerns, and history of serious illness/seizures/fainting.)
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Do you wear contact lenses? __Yes __No
CURRENT MEDICATIONS: Copy information from medication labels for all medicines - prescription & over-the-counter. |
||
Name of medication | Dose | Frequency |
example:__ tetracycline _____ __________________________ __________________________ __________________________ __________________________ __________________________ __________________________ |
___ 250 mg _________ ____________________ ____________________ ____________________ ____________________ ____________________ ____________________ |
_____ twice/day ________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ ________________________________________ |