1、公共实验室使用权限申请表Access application to public laboratory 使用人姓名 (User）学号 (ID)所在中心 (Center）指导教师（Supervisor）年级专业 (Grade&Major)联系电话 (TEL)申请使用时间 (Period) From to (m/d/y) 申请使用的实验室(Lab name applied for)申请使用的仪器设备（ Equipment）申请使用的通风橱(Fume hood)申请使用的实验台(Bench)实验室使用申请理由：（简述实验概况、所需仪器设备、可能产生的废液等情况）The reason of apply
2、ing for Lab（including the experimental process, equipments required and the waste produced ,etc.） 使用人签名(Signature of User)： 申请时间(Date)： (d/m/y)本人承诺：1遵守实验室相关制度，确保人身安全。2正确使用实验室设备及仪器，保证实验室设备及仪器安全。使用后必须填写仪器设备使用记录。严禁操作未经申请的仪器设备。如因操作不当损坏仪器的，须照价赔偿。3离开实验室前应清理器材工具，检查是否关好水、电、气、门窗和空调。本人与其他实验人员已阅知以上实验室安全责任要求，保证
3、切实履行实验室安全责任。如因个人违反规章制度而发生意外事故，造成人身伤害和财产损失的，本人自愿承担造成的一切后果。I promise:1. Comply with the disciplines of the lab to make sure personal safety.2. Operate the public equipments properly to make sure the safety of equipments. The using record must be filled after use. It is not allowed to operate the instr
4、ument without the application. If the instrument is damaged due to improper operation, compensation shall be paid according to the price.3. Before leaving the lab, clean the equipment tools and check the water, electricity, gas cylinders, doors and windows, air conditioning closed.I have read the ab
5、ove laboratory safety responsibility, and I will fulfill my laboratory safety responsibilities. If an accident occurs due to my violation of the rules and regulations, resulting in personal injury and property damage, I will undertake all the consequences voluntarily.申请人签名(Signature of Applicant)： 申
6、请时间(Date)： (d/m/y)指导教师承诺：1借用教师或借用学生的指导教师为借用期间实验室安全责任人，在借用期间须保证实验室的安全。2对实验人员进行必要仪器使用和实验技能指导和培训，保证实验操作的规范及仪器设备的正常使用。如因操作不当损坏仪器的，须照价赔偿。3督促实验人员按时完成实验项目。本人已阅知以上实验室安全责任要求，保证切实履行实验室安全责任。4. 公共实验室拟采取按申请时间收费的制度，望各位老师妥善填写申请期限。Supervisor promises:1. The supervisor is responsible for the laboratory safety during
7、 the application period. And the supervisor must ensure the safety of the laboratory, including electricity, water, gas and fire safety. 2. Necessary training must be made to the student to make sure the normal operation of the equipment and instruments. If the instrument is damaged due to improper
8、operation, compensation shall be paid according to the price.3. Supervise the student to complete the experiment plan on time.4. You should pay for the fixed fume hood and the bench according to the period.I have read the above laboratory safety responsibility, and I will fulfill my laboratory safety responsibilities.指导老师签名(Signature of Supervisor)： 时间(Date)： (d/m/y) 实验室负责人意见(Lab managers opinion)实验室主管领导意见(Lab leaders opinion)
