© Copyright 1999 by Plymouth Schools Foundation, Inc.

Table of Contents

Plymouth Public Schools

Science Program
SECTION I

Safety Regulations for Science Students

While working in the science laboratory, you will have certain important responsibilities that do not apply to other classrooms. You will be working with materials and apparatus which, if handled carelessly or improperly, have the potential to cause injury or discomfort.

A science laboratory can be a safe place to work if you, the student, are foresighted, alert and cautious. The following practices will be followed.

1. Perform only those laboratory operations and activities in which you have received instructions and permission. Always read and understand lab procedures in advance of doing the lab activity.

2. Be familiar with the locations of the fire extinguishers, eye wash and shower stations, and fire alarm box. Be able to operate them correctly should an emergency requiring their use arise.

3. All persons performing science activities involving hazards to the eyes must wear approved eye-protective devices. All persons in dangerous proximity to such activities must be likewise equipped. For example, in chemistry laboratory experiments involving hazardous substances or procedures and in general science laboratories when rocks or minerals are being chipped or ground, all persons must be protected. If contact lenses are being used they must be removed before continuing the laboratory activity.

4. Never carry hot equipment or dangerous chemicals through a congestion of students.

5. Report to the teacher at once any personal injury sustained--burn, scratch, cut or corrosive liquid on skin or clothing--no matter how trivial it may appear.

6. Only teachers and laboratory assistants shall have access to the stockroom. Keep out of stockrooms or preparation areas, unless the teacher or lab aide request your presence.

7. Long sleeves should be rolled up above the wrist. Coats and sweaters should be removed. Long hair should be confined during a laboratory activity, especially when an open flame is nearby. Dangling jewelry should be removed for safety.

8. While in the laboratory, keep your hands away from your face, eyes and body. Wash hands thoroughly at the conclusion of a laboratory period.

9. When heating test tubes, do not look down into the tube while heating it or point it in the direction of any student during the process.

10. When collecting gas by water displacement, remove the delivery tube from the generating flask prior to removing the heat so that water will not be forced back into the hot generator.

11. Always provide a cloth or towel to cover any apparatus used to generate gases.

12. Always test for odor of chemicals by wafting your hand over the container and sniffing cautiously.

13. Never taste chemicals or drink from a beaker in the laboratory. Never consume food prepared in laboratory glassware.

14. To cut small diameter glass tubing, use a file or tubing cutter to make a deep scratch. Then wrap the tubing in a paper towel before bending the glass away from you with your thumbs. Fire polish all ends.

15. When bending glass, allow time for the glass to cool before further handling. Hot and cold glass have the same visual appearance. Determine if an object is hot by bringing the back of your hand up close.

16. Never pour reagents back into bottles or exchange stoppers of bottles or lay stoppers on the table.

17. Put all solid waste in proper receptacles. 1) Glass in glass debris box. 2) Solid waste goes in plastic bag as directed by your teacher and held for late-disposal.

18. When diluting acids, always pour acids into water, never the reverse. Combine the liquids slowly while stirring the mixture.

19. Handle squeeze bottles, dropping bottles and medicine droppers with extreme care to prevent squirting or spilling.

20. Wear face shield or protective goggles when performing experiments or demonstrations which are hazardous because of spattering or potential explosion.

21. In case of a burn from an acid or alkali, wash the affected area immediately with plenty of running water. If the eye is involved, irrigate it without interruption for at least 10 minutes. Report the incident to your instructor immediately.

22. In removing an electrical plug from its socket, pull the plug, not the electrical cord.

23. Do not insert unprotected fingers into cages containing laboratory animals. Wear heavy rubber or leather gloves when it is necessary to handle the animals.

24. Notify the instructor when you recognize hazardous conditions with equipment or materials (e.g., defects in electrical equipment, leaking containers, sharp edges on glassware, etc.)

25. Chemicals are never to be removed from the classroom or storage areas by students. If special chemicals are required for science projects, arrangements can be made by your parents/guardians for their purchase and transportation home.

26. Desks and laboratory benches should be properly cleaned at the end of each laboratory activity.

SECTION II

Special Instructions for Chemistry Students

1. Read "Safety Regulations for Science Students."

2. Never taste chemicals or drink from a beaker in the laboratory.

3. Always waft odors toward your nose with your hand. Never breathe them directly.

4. Wash your hands after handling chemicals.

5. Never wear expensive clothing if laboratory work is to be done. Your father's old shirt will give your clothes some protection if a lab coat is not available. Roll sleeves up above the wrists.

6. Use the proper type of tong when handling hot crucibles or beakers. Crucibles must be held at the very end of crucible tongs. Place hot crucibles on a ceramic square or on the base of a ring stand. DO NOT ALLOW HOT OBJECTS TO CONTACT THE ARBORITE (FORMICA) TABLE SURFACES.

7. When evaporating a solution to dryness in an evaporating dish, place an inverted beaker above the dish as protection from spattering. If available, use a hot plate with a temperature control, or heat lamps.

8. Treat a test tube with contents that you are heating like a loaded gun. Never point it in anyone's direction. Hold it at an angle and heat it from the top down. While being heated, a test tube should never be more than half full. Keep the test tube moving in the flame. Generally, a beaker is more suitable for heating liquids.

9. Always douse any area which has contacted acid or caustic materials with lots of water. If the eye is involved, irrigate it without interruption for ten minutes.

10. Erlenmeyer and Florence flasks should be clamped to ring stands in addition to being supported on wire gauze and a ring.

11. Check bent glass and rubber tubing to ensure that a flow of gas is not obstructed.

12. To cut small diameter glass tubing with a file, use a new file to make a deep scratch. Then wrap the tubing in a paper towel before bending the glass away from you with your thumbs. Fire polish all ends.

13. To insert thermometers on glass tubing into rubber stoppers, wet the glass and stopper-hole with water or glycerine beforehand. Never push hard, but use a turning motion. Do not use glycerine if the assembly is to be exposed to nitric acid. Wrap stopper in cloth as well as the glass tubing to be inserted.

14. Remove glass thermometers or tubing as soon as possible after use to prevent the glass from "freezing" to the stopper. If the glass has frozen, either split the stopper with a sharp knife or bore the tube out of the stopper with a cork borer.

15. Sink drains should be thoroughly flushed with water after spilling out reagents.

16. Never return unused solutions to stock containers or reagent bottles.

17. Learn and use the correct technique for pouring chemicals from reagent bottles. Hold the glass stopper above the hand and between the index and middle finger so that the same hand can grasp the bottle.

18. When pouring chemicals from beakers, use a stirring rod to direct the flow.

19. Be especially careful with organic solvents, many of which are highly flammable and some of which are toxic.

20. Never add water to concentrated acid. The concentrated acid should always be added in small quantities to the water, stirring continuously.

SECTION III

Special "Safety Regulations for Physics Students"

1. Read "Safety Regulations for Science Students".

2. In using hypsometers, caution pupils to direct outlets for steam away from their own and other students eyes. In experiments involving the use of two valves, one of them must always be open.

3. Pupils should be taught never to grasp any electrical device which has just been used. Most electrical devices are hot after use, and serious burns may result if the degree of heat is not ascertained before it is grasped.

4. Pupils should be instructed never to "short circuit" dry cells or storage batteries. High temperatures developed in the connecting wires can cause bad burns.

5. Students should be cautioned about the danger of shock from the secondary of a induction coil.

6. In removing an electrical plug from its socket, pull the plug, not the electric cord.

7. In inserting an electrical plug, hold plug so that any flashbacks due to a short circuit will not burn the palm of the hand. This applies as well to holding a soldering iron.

8. When using an electric current, avoid bringing both hands in contact with "live" sections of the circuit. If possible, use but one hand at a time in all manipulations involving an electrical circuit.

9. Connections should not be made to electric light sockets for the purpose of operating electrical appliances or for electric extensions or portable lamps.

10. Multiple plugs should not be used in electrical wall outlets. Semi-permanent electrical connections should not be made to wall outlets. Electrical apparatus consuming more than 1,100 watts should not be connected to wall outlets. Motor driven apparatus should not be connected to wall outlets unless such apparatus is essentially portable. Under no circumstances should a motor requiring a starting current of more than 10 amperes be connected to a wall outlet.

11. Care should be observed in teacher and pupil handling of a storage battery. It is a source of danger in spite of its low voltage, because of the acid it contains and because of the very high current which may be drawn from it on a short circuit.

12. In the handling of radio equipment by teachers and pupils, the following precautions should be observed:

A. Make certain that the current is off before putting hands into the radio.

B. Be sure that there is a "bleeder" (high resistance), across the output of the power supply; otherwise, a severe shock from the charged condenser may result.

C. In handling the so-called transformerless type of radio, where the tubes are series connected and the set works directly from the line, caution must be observed to prevent any grounded metallic object from coming in contact with the metallic chassis.

D. In using a standard transformer radio, pupils must be cautioned on the handling of "B" voltages; the high voltage secondary is in the order of 600 volts A.C. and the rectified "B" voltage about 300 volts D.C.; severe burns and shock can result from contact.

13. A. Care should be taken to avoid burns to the skin when using a soldering iron or gun.

B. Care should be exercised when unsoldering electronic equipment to avoid spattering of the melted solder when a wire is pulled away from its formed connection.

14. In using a pressure cooker to demonstrate variation of boiling points with pressure, be sure to examine the safety valve before use, to make sure it is in working order. Also, do not allow the pressure to go above 20 pounds.

15. Exercise care in demonstrating, adjusting or using image tubes of television receivers or cathode ray oscilloscopes when these tubes are removed from their protective housing.

SECTION IV

Special Instructions for Biology Teachers and Students

1. Read "Safety Regulations for Science Teachers".

2. Great care should be exercised by pupils in securing epithelial cells from the inside of the cheek for study under the microscope. Only smooth sterilized (single-use) splints (wood) or the blunt edge of a flat sterilized (single-use) toothpick should be used. Pointed instruments or any part of a scalpel should never be used for this purpose.

3. Handling laboratory animals - Rats, mice, guinea pigs and other laboratory animals should be handled gently by students so as not to unduly excite the animal into biting. Gloves made of thick rubber should be available and used whenever necessary;; that is when there is danger of biting (by excited animals, injured animals, new additions to cage, pregnant or feeding female, etc.). Each finger of the rubber gloves can be reinforced with adhesive tape for added protection. Students and visitors to the laboratory should be cautioned not to insert finger in wire mesh of cage. Appropriate signs should be displayed about cage such as "Keep Hands Off". Only specially trained members of the laboratory squad should be permitted to handle laboratory animals. Poisonous snakes should not be kept in the laboratory.

4. Use of formalin (40% solution of formaldehyde) - Specimens preserved in formalin should be thoroughly washed in running water for 24 hours before being handled by students. In taking specimens out of formaldehyde, students should either wear rubber gloves or else use tongs or forceps--depending on the size of the specimen. Adequate ventilation should be provided in any room where formalin is used.

5. Precautions for field trips

A. Pupils should be instructed about identification of poison ivy, poison sumac, poisonous snakes, etc.

B. First aid kits should be taken along on all field trips.

C. Students should be instructed as to the proper clothing to take along on a field trip to avoid illnesses due to undue exposure, etc.

D. Parental "consent slips" should be required of all pupils.

6. When pupils are to handle tools in constructing projects, etc., special instructions should be given where necessary.

7. Pupils should submit all electrical work to the instructor for approval before putting into use.

8. Pupils are not to handle steam pressure sterilizers, incubators, etc., without special instructions given beforehand.

9. Home experiments - Pupils should be cautioned that fermenting or decaying materials should NOT be kept sealed for too long a period of time.

General Suggestions on Technique and Procedures

1. Teachers and laboratory assistants should observe all the precautions listed in Sections II and III.

2. Bread mold and pollen from flowers - In handling flowers and bread mold, care should be taken that pollen or spores are not excessively distributed through the classroom. Some students may be allergic to pollen or spores.

3. Blood experiments - CAUTION: Do not use student volunteers!

Only sterile needles or lancets should be used by the teacher for pricking his finger to draw blood. Blood should be drawn from the dorsal side of finger just in back of the cuticle. Rub finger with alcohol before pricking it and cover with a Band-Aid afterward. A lancet should NOT be used more than ONCE. Use a projection system to project the slide on a monitor.

Sharps should be discarded in a proper container and all wastes should be red bagged.

4. Osmosis experiments - In the osmosis experiment great care should be exercised in inserting the thistle tube through the rubber stopper. (A rubber stopper is commonly used to support the thistle tube in the clamp of the ring stand.) Always wet the tube and use a twisting motion while applying pressure. Do not grasp the thistle tube by the bowl; grasp the tubing of the thistle tube near the rubber stopper.

5. Only fresh materials should be used at all times. do not use decayed or decaying material. If material is to be used for more than one day, keep it in a refrigerator or in alcohol.

6. Extraction of chlorophyll -

A. Only pyrex or other hard glass test tubes should be used

B. Use an electric heater of the immersion type or a water bath heated by an electric hot plate, instead of an open flame or a gas heated water bath for heating alcohol

C. Keep open flames away from alcohol or alcohol vapors; if alcohol ignites in beaker, cover beaker with a glass plate to extinguish; if burning alcohol runs over the table, use CO₂ extinguisher.

D. Stop heating before removing the cover; pressure should be down to normal before removing cover

E. Be sure to open the stop cock before releasing the clamps

F. It may be desirable to place a protective screen around operating pressure cookers and autoclaves

8. Careful use of dissecting instruments and dissection material in laboratory work, through instruction and warning, will avoid cuts and possible infection. Special care should be taken when cleaning scalpels and needles.

9. Pathogenic bacteria should not be cultures. Only non-pathogenic forms from reliable sources should be used. Exposed Petri dishes should be soaked in a strong disinfectant (carbolic acid, cresol, lysol, etc.) before being washed. An alternative to the use of these strong disinfectants is to first sterilize the exposed Petridi dishes in an autoclave, then pour off the hot liquid agar while wearing protective gloves. The dishes can then be soaked in a solution of alconox or of another household cleanser. Rubber gloves should be worn during this operation. Dishes passed around for inspection should be bound together with Scotch tape.

10. Teachers and laboratory assistants should take special care to avoid the dangers indicated when pupils handle any of the following:

A. Large paper cutter (cuts)

B. Formaldehyde (fumes dangerous to the eyes and throat)

C. Denatured alcohol and wood alcohol

D. Apparatus left hot by use, i.e., steropticon, microprojector, etc. (burns); do not put hot projectors into cases; allow them to cool off first

E. Carpentry tools (wounds)

F. Electrical apparatus and equipment (shocks)

11. Ether is not to be used.

12. When testing for proteins, pains should be taken to avoid the possible spattering of the nitric acid when heating. This test tube and its contents should be rinsed with water before ammonium hydroxide is added. Nitric acid, like sulphuric acid and other acids, is corrosive and produces bad burns, even when cold. Pupils should never handle a test tube or bottle containing concentrated nitric acid. If the Biuret test for proteins is used, the same precautions should be exercised in handling the potassium hydroxide as in handling the nitric acid.

13. Wire loops used for transferring cultures of bacteria should be flamed after each transfer is made.

14. If pipettes are to be used to transfer liquids:

A. The teacher should first demonstrate its use; pupils should then practice with colored water

B. CAUTION: Do not use pipettes for fluids which may be harmful; e.g., hypertonic salt solutions, indicators, alcohol, organic solvents, etc.

15. Dissections:

A. Keep the unoccupied hand away from the cutting edge of the dissection tool

B. Wash hands thoroughly with soap and warm water--especially under the nails

C. Properly dispose of wastes. These do not go into the general trash but must be separately bagged for hazardous waste disposal.

16. Care should be used when heating Fehling solution in a test tube due to its caustic nature and its tendency to "bump" violently when boiled.

17. When using a centrifuge, be sure to use a second similarly shaped test tube containing an equal amount of water.

18. Where the use of a razor-blade is required for cutting plant parts, the blade should be of a single edge type.

SECTION V

Safety on field Trips

• A FIRST-AID KIT IS REQUIRED whenever a group takes a trip away from school. This kit should be checked out from the nurse's office. If the field trip is conducted into an area which has been known to harbor poisonous snakes, the first-aid kit shall include a snake bite kit. Whenever a first-aid kit is used, the nurse should be notified so the contents can be renewed if necessary.

• The safety and comfort of the students while participating in field experiences are important considerations, and should be included as integral parts of the planning process.

• Students should be instructed as to the most appropriate types of clothing to wear on specific field trips.

• Students should be instructed about harmful plants and animals that are likely to be encountered on specific field trips.

• Students should be instructed about the potential hazards that may be encountered in any industrial complex visited.

• Students should be instructed to wash their hands and faces with a strong soap immediately after the trip as a precautionary measure against any toxins encountered.

• Life preservers are required for each student when trips are conducted on deep water.

• When planning a field trip away from school grounds, allow for one adult supervisor per 10 students when you have reached your destination. Also allow for one adult supervisor on each bus when multiple buses are being used for the trip.

• A list of all students going on the field trip must be left at the main office of the student's school. Included on the list should be the students' names and grade as well as the destination of the trip and how to reach the group if necessary, i.e., phone number of destination, etc.

• No student will be allowed to participate on any field trip activity unless they have returned the "Field Trip Approval Form" properly filled in.

PLYMOUTH PUBLIC SCHOOLS

SCIENCE PROGRAM

Field Trip Approval Form

School: ____________________________

Grade: (Circle One) 7 8 9 10 11 12

Homeroom: __________

Dear Parent/Guardian

This is to inform you that your son/daughter ________________________________

is scheduled to participate in a field trip on _________________________________

Destination __________________________________ Telephone # _____________

Departure Time ____________ Return Time ______________Cost _____________

Method of Transportation ______________________________________________

Students should dress appropriately for the day's outing. If the trip includes lunch,

please provide the following:

1. Lunch money _____________(Amount) 2. Bag lunch _______________

3. Other arrangements/restrictions (explain) ________________________________

I fully understand that all reasonable precautions to safeguard his/her welfare are being undertaken by his/her teachers and chaperones, and I do NOT hold the school authorities LIABLE in the event of unavoidable accidents or incidents.

Medications may be dispensed by teachers if they meet school medication policy. Please note, however, that teachers cannot dispense psychotropic drugs - MGL 71, S 54B, for example Ritailin, Dexedrine, Methylphenidate.

Medication Request: No Yes

Name of Medication ___________________ Dosage _______Time to be given ________

Additional Information_____________________________________________________

_______________________________________________________________________

• I give permission for my son/daughter to attend the above field trip.

_______________________________ _______________________________________

Son/Daughter Name Parent/Guardian Signature

• My child is unable to attend the field trip. I understand that he/she is expected to be in school where academic work and core classes will be provided.

_______________________________ _______________________________________

Son/Daughter Name Parent/Guardian Signature

• Yes, I am willing to chaperone. I can be reached at (Tel.#) _____________________

( A gentle reminder that School Committee Policy says there is No smoking at any time on school grounds or during school sponsored events by anyone.)

Teacher Information

Field Trip Advisor: Please check within parenthesis ( ) periods involved in field trip.

Teachers: Please write in subject after class period and sign your name indicating that you have made note of field trip date for your records. (It is the responsibility of every student to make up work missed by this absence.)

Subject Signature

Period 1 ( ) ___________________ ______________________

Period 2 ( ) ___________________ ______________________

Period 3 ( ) ___________________ ______________________

Period 4 ( ) ___________________ ______________________

Period 5 ( ) ___________________ ______________________

Period 6 ( ) ___________________ ______________________

Period 7 ( ) ___________________ ______________________

SECTION VI

Guiding Principles for Use of Animals in Elementary and Secondary Schools

1. In biological procedures involving living organisms, species such as plants, bacteria, fungi, protozoa, worms, snails, or insects should be used wherever possible. Their wide variety and ready availability in large number, the simplicity of their maintenance and subsequent disposal makes them especially suitable for student work. In mammalian studies, non-hazardous human experiments are often educationally preferable to the use of species such as gerbils, guinea pigs or mice.

2. No procedure shall be performed on any warm-blooded animal that might cause it pain, suffering, or discomfort or otherwise interfere with its normal health. Warm-blooded animals include man, other mammals such as gerbils, guinea pigs, mice, rabbits, hamsters and rats. It also includes birds, such as hens, quail, and pigeons. This means that a student shall do unto other warm-blooded animals only what he can do to himself without pain or hazard to health.

3. No surgery shall be performed on any living vertebrate animal (mammal, bird, reptile or amphibian).

4. No lesson or experiment shall be performed on a vertebrate animal that employs microorganisms which can cause disease in man or animal, ionizing radiation, cancer-producing agents, chemicals at toxic levels, drugs producing pain or deformity, extremes of temperatures, electric or other shock, excessive noise, noxious fumes, exercise to exhaustion, overcrowding or other distressing stimuli.

5. Animal observations must be directly supervised by a competent science teacher who shall approve the plan before the student starts work. Students must have the necessary comprehension and qualifications for the work contemplated. The supervisor shall be responsible for their non-hazardous nature and shall, personally, inspect experimental animals during the course of the study, to ensure that their health and comfort is fully sustained.

6. Vertebrate studies shall be conducted only in location where proper supervision is available: either in a school or an institution of research or higher education. No vertebrate animal studies shall be conducted at a home (other than observations of normal behavior of pet animals such as dogs or cats).

7. In vertebrate studies, palatable food shall be provided in sufficient quantity to maintain normal growth. Diets deficient in essential foods are prohibited. food shall not be withdrawn for periods longer than 12 hours. Clean drinking water shall be available at all times (and shall not be replaced by alcohol or drugs).

8. Birds' eggs subjected to experimental manipulations shall not be allowed to hatch; such embryos shall be killed humanely no later than the nineteenth day of incubation. If normal egg embryos are to be hatched, satisfactory arrangements must be made for the humane disposal of chicks.

9. In the rare instances when killing of a vertebrate animal is deemed necessary, it shall be performed in an approved humane (rapid and painless) manner by an adult experienced in these techniques.

10. Projects involving vertebrate animals will normally be restricted to measuring and studying normal physiological functions such as normal growth, activity cycles, metabolism, blood circulation, learning processed, normal behavior, reproduction communication or isolated organ techniques. None of these studies requires infliction of pain.

11. The comfort of the animal observed shall receive first consideration. The animal shall be housed in appropriate spacious, comfortable sanitary quarters. Adequate provision shall be made for its care at all times, including weekend and vacation periods. The animal shall be handled gently and humanely at all times.

12. Respect for life shall be accorded to all animals, creatures and organisms that are kept for educational purposes.

Approved by : The Humane Society of the United States

The Veterinary Advisory Committee

Robert C. Bay, D.V.M., Chairman

The Special Study Committee on the use of Animals in Biomedial Research & Testing , Barbara Orlans, Ph.D., Coordinator

GENERAL LAWS OF MASSACHUSETTS

CHAPTER 71

SECTION 33

REGULATION OF VIVISECTION AND DISSECTION; PENALTY FOR VIOLATION,

No person shall, in the presence of a pupil in any public school, practice vivisection, or exhibit a vivisected animal. Dissection of dead animals or any portions thereof in such schools shall be confined to the classroom and to the presence of pupils engaged in the study to be promoted thereby, and shall in no case be for the purpose of exhibition. Violation of this section shall be punished by a fine of not less than ten nor more than fifty dollars.

SECTION VII

Safety Rules for a Science Project

1. In order to protect the public, no explosive, highly flammable, corrosive or highly poisonous materials may be brought to the fair. All chemicals must be protected so that there will be no possibility of damage to spectators, neighboring exhibitors, etc. Use of rocket fuels, armed rockets and explosives of any kind is prohibited. This is very important in the crowded conditions at the science fair.

2. Due to the fire hazard, there can be no open flame, torch, or burner. Electrical heating units must be well protected and must not be near the front edge of the exhibit.

3. Projects dealing with radiation, either from x-rays or radioactive materials must present no hazard to the public.

4. Live animals must be securely caged, properly fed, watered and cleaned and not be mal-treated in the course of the exhibit. Plants likewise must be properly cared for. Provision should be made to prevent offensive odors.

5. No live, poisonous reptiles may be exhibited.

6. No pathogenic cultures may be exhibited.

7. Molds and bacterial cultures must be covered carefully and sealed tightly at all times.

8. Hypodermic needles and syringes must not be left on display. Any exhibit which includes them will be automatically disqualified and removed from the fair.

9. All moving parts of machines must have protective covering. Watch particularly for vacuum pumps.

10. Push buttons and levers must be securely mounted on exhibits. They must not be attached to tables or walls.

11. Material and construction must be durable. All movable parts must be firmly attached. Power-driven movable parts must be protected with guards.

12. All electrical apparatus must be constructed according to standard electric safety laws. If you are in doubt, consult a competent electrician.

13. All exhibits which require house current for operation or illumination must be designed for operation on alternating current at 110-115 volts. If batteries are used, they should be storage batteries to insure continuity of operation. Dry cell batteries may be used if they are frequently renewed.

14. Doorbell push-buttons must not be used to control 110-115 volt apparatus. Use toggle or push-button switches designed for the proper load. Non-insulated switches, such as knife switches, will not be permitted.

15. All wiring, switches and metal parts carrying current must be completely enclosed by barriers that will positively prevent observers from reaching into the exhibit and receiving an electrical shock. Both front and back of display must be so enclosed. all chassis should be grounded.

16. All electrical joints must be properly secured and insulated.

17. Nails, tacks and uninsulated staples must not be used for fastening wires. Use porcelain and other suitable types of insulators.

18. All wire used in construction of exhibits must be selected and insulated for voltage in use. There must not be any exposed wires.

19. All capacitor banks must have short-out provisions.

20. All solvents must be in proper containers.

21. All mercury containers must be equipped with spill pans.

22. All pressure vessels should have relief valves.

23. All laser beams must be contained and pulsed electrical circuitry isolated.

24. Each project being done to completion (grades 9-12) must fill out form: Part #1 found in Appendix A.

25. Each project that involves Vertebrate Animals, Human Subjects, Recombinant DNA, or Tissues (grades 7-12) must fill out all appropriate forms in Appendix B

Guidelines for Students to Use Animals in

Science Fair Projects

The Plymouth Science Fair has adopted the guidelines set up by the Massachusetts State Science Fair. These guidelines are issued to prevent cruel and abusive treatment of animals during the preparation of science fair projects. (See Appendix for state guidelines)

1. Students are strongly urged to select plants or invertebrate animals for science investigation. Among animals, invertebrates are especially suitable because of their variety and availability.

2. If vertebrate animals are used for experimental purposes, such experiments must be pre-planned and conducted in such a manner that respect for basic animal life and all humane considerations are fully understood and observed by the student.

3. Students using animals for investigation must provide for the proper housing, food, water, exercise, cleanliness, handling, and protection from environmental extremes of such animals at all times.

4. No experiments using warm-blooded animals shall involve surgery, drugs, anesthetics, ionizing radiation, pathogens, or carcinogens.

5. A student who has worked with living animals must submit a certificate of compliance, (see state forms in appendix) properly filled out, with his registration material for the Plymouth Science Fair.

6. Any project which does not conform to these guidelines, or which in any way involves cruel and abusive treatment of an animal, will be excluded from the fair.

7. Each student submitting a project using animals must have an adult supervisor who is qualified in the proper care of animals. This supervisor must assume the primary responsibility for compliance with these guidelines.

Any student or teacher who is unsure of a project's compliance with the above guidelines should describe the project in a letter to:

Nicola Micozzi, Jr.

Science Coordinator

Plymouth Public Schools

253 South Meadow Road

Plymouth, MA 02360

PLYMOUTH PUBLIC SCHOOLS

PILGRIM SCIENCE FAIR

Certificate of Compliance

(State forms in appendix also need to be filled out)

(For use of vertebrate animals in science fair projects)

Date _________________

This is to certify that _____________________________________, a student enrolled at

the ________________________________ school, has planned and prepared his project

entitled, _________________________________________________________________

________________________________________________________________________

in full compliance with the Massachusetts State Fair guidelines for the use of animals in science fair projects.

Permission to start this project was granted on _______________________.

(Date)

Signed _______________________________

(Science Coordinator)

Signed _______________________________

(Student)

Signed _______________________________

(Supervising Teacher)

If applicable, complete the following:

This project was performed under the supervision of another qualified adult,

Signed ______________________________ Title ______________________________,

at the following __________________________________________________________.

PLYMOUTH PUBLIC SCHOOLS

PILGRIM SCIENCE FAIR

Chemical Release Form

Student _______________________ Course ____________________

Teacher _______________________

I requested the following chemicals for my child's science project:

Cost: Chemical Name: Amount: Hazard:

$_______ ______________________________ _____ _____________________

_______ ______________________________ _____ _____________________

_______ ______________________________ _____ _____________________

_______ ______________________________ _____ _____________________

_______ ______________________________ _____ _____________________

_______ ______________________________ _____ _____________________

_______ ______________________________ _____ _____________________

_______ ______________________________ _____ _____________________

$______ Total Cost

I have been informed of the proper handling procedures and special hazardous qualities of each of the above chemicals. I will supervise my child in their use and disposal. I will NOT hold the school authorities LIABLE in the event of injury caused by any of the above chemicals. I also agree to pick up the requested chemicals at school and transport them home in my personal vehicle.

Date_____________________ Signature _________________________________

(Parent/Guardian)

APPENDIX A

SAFETY REVIEW

PART 1

PART 2

ATTENTION

Science Department Teachers

Please make a copy of the "Teacher-Supervisor/Research Plan/Safety Review Certification #1, Parts 1 and 2 (see attached) for each of your students. They must fill out forms and present to MSSF Scientific Review Committee (SRC) before experimentation begins. Teacher-Supervisor is required for each student. Also, if student is performing research or experimentation in any of the following categories -- Vertebrate Animals, Human Subjects, Recombinant DNA, Tissue, Pathogenic Agents or Controlled Substances, the student or teacher must obtain the proper forms as outlined in 1991 Participant's Handbook, and submit them to the MSSF Scientific Review Committee before beginning experimentation.

For Further Information, contact: Mary H. Young at North Quincy High School, (617) 984-8996.

SAFETY REVIEW

REQUIREMENTS AND INFORMATION FOR TEACHER-SUPERVISORS

1. Chemical Usage - I have reviewed with the student current safety standards for each chemical to be used in the project and discussed the relevant safety information, including toxicity data, proper handling techniques, and methods for disposal of each chemical.

NOTE: If a chemical is considered or suspected of being carcinogenic or mutagenic (consult the MSDS Listing for the specific chemical); available only by prescription in the USA; radioactive; explosive; or highly toxic (LD50 of 50 mg/kg or less for oral comsumption/LD50 of 200 ppm or less for inhalation of the gas or vapor will vary according to species), prior to the beginning of the research a Research Plan must be completed and approved by the Scientific Review Committee (SRC)

2. Equipment Usage - I have reviewed with the student the proper operational procedures and safety precautions for each item of equipment that will be used for the project.

NOTE: If a project involves high voltage equipment (220 volts or greater); unshielded ionizing radiation of 100-400 nm wavelength; welding; lasers; x-ray or nuclear radiation, prior to the beginning of the research a Research Plan must be completed and approved by the SRC.

3. Experimental Techniques - I have reviewed with the student the releant safety precautions associated with the experimental techniques that will be used during the project.

4. Laboratory or Field Test animals - I have reviewed with the student the appropriate procedures required for the safe handling and keeping of any invertebrate or vertebrate laboratory or field animals that will be used in the project. NOTE: All projects involving live vertebrates must be approved by the SRC prior to the beginning of research.

5. Cell Cultures, Mocroorganisms, or Tissue - I have reviewed with the student the appropriate safety procedures associated with handling any cell cultures, microorganisms, or vertebrate animal and human tissue to be used in the project. NOTE: These projects must also be approved by the SRC prior to the beginning of research.

PART #1

COMPLETION OF FRONT AND BACK OF FORM IS REQUIRED FOR ALL PROJECTS

Student's Name (type) _____________________________________________________

Home Address _____________________________________Hm.Tel.# ( )__________

Student's School ___________________________________Sch.Tel.# ( )__________ Student's Signature _______________________________________________________

Parent/Guardian's Signature ________________________________________________

Project Title _____________________________________________________________

_______________________________________________________________________

ISEF Affiliated Fair _______________________________________________________

TEACHER APPROVAL - PRIOR TO RESEARCH

I agree to sponsor the student named above and assume the responsibility for compliance with all existing ISEF Rules and approve the research plan on the reverse side. I have also conducted a safety review as outlined on page 4.

Teacher-Supervisor Name (type) ___________________________________________________

Work Address _______________________________________________Phone______________

City _________________________________ State ________________ Zip Code ____________

Starting date of laboratory or field research ___________________________________________

Name and address where laboratory or field research will be done _________________________

______________________________________________________________________________

Teacher-Supervisor Signature ___________________________________ Date ______________

Signed for all projects prior to the start of experimental research.

STUDENT APPROVAL

I understand the risks and possible dangers to me of the proposed research plan. I will adhere to all MSSF/SEF Rules when conducting this research.

Student's Signature __________________________________________ Date ____________________

PARENT/GUARDIAN APPROVAL

I have read and understand the risks and possible dangers involved in the Sponsor-approved research plan. I consent to my child participating in this research.

Parent/Guardian's Signature ___________________________________ Date ____________________

SRC APPROVAL - PRIOR TO RESEARCH (WHEN NECESSARY)

SRC Review - I certify that the committee has carefully studied this research proposal and certify that all required certifications are included. My signature indicates approval of this research proposal prior to the beginning of experimental work by the student.

Signature ___________________________________________________________Date ___________

Local Fair SRC Chairperson or Affiliated Fair SRC Chairperson

Signature required for all projects involving vertebrate animals, humans, recombinant DNA, tissue or pathogenic agents/controlled substances prior to the start of experimental research.

NOTE: Major deviations from the original plan must be approved prior to changes in experimental procedures being used by the student.

SCR APPROVAL - PRIOR TO COMPETITION AT AN ISEF-AFFILIATED FAIR

I certify that this project complies with all ISEF Rules.

Signature ____________________________________________________________Date____________

Affiliated Fair SRC Chairperson

Signed for all projects, before competition at the affiliated fair.

This form, with all signatures, must be submitted to the ISEF Scientific Review Committee for students named as ISEF Finalists.

RESEARCH PLAN - PART II OF CERTIFICATION #1

MUST BE COMPLETED PRIOR TO RESEARCH

(See instructions on page 29)

Student's name ___________________________________________________________

These areas of study require approval from a Scientific Review Committee (SRC) before you begin experimentation. Check one or more of the appropriate items below. Student must obtain and complete the appropriate forms for any of the first five categories as outlined in the 1994 MSSF Participant Handbook.

Vertebrate Animals

Pathogenic Agents

Controlled Substances

Recombinant DNA

Human/Animal Tissue

Human Subjects

None of the Above

NOTE: Please type here or attach a separate computer printout.

1. Problem and Hypothesis:

2. Methods or Procedures (use additional sheets and include your complete procedure):

3. Bibliography (minimum of 3 major sources):

(Vertebrate animal experiments must include at least one animal care reference source.)

INSTRUCTIONS - COMPLETION OF THE RESEARCH PLAN

(Part #2 of Certification #1)

Each Research Plan must provide the information as described below and must be completed prior to the start of the research.

1. Problem and Hypothesis

The student should present in this section the ideas behind the research. Why is the research to be done? There should be a reason for wanting to do the research. Some explanation should be given as to what the research is expected to show and what is to be learned. The last statements of this section should include a specific purpose of the research and an applicable hypothesis. The purpose should reflect a very close relationship with the title. Attach additional sheets if needed. a specific statement of the Hypothesis(es) is to be included.

2. Methods or Procedures

Methods to be used in the research shouldbe presented in detail. For example, if an animal or embryo is to be treated with drugs, the name of the drug, the concentration and amount of the drug to be administered and the method of administration should be clearly outlined. It should be very clear that the student knows exactly what he or she is to do prior to the initiation of the research. If blood is to be drawn, the methods for obtaining the blood samples and the types of analyses to be carried out should be given. If tissue samples are to be taken, the methods of obtaining the tissue should be outlined. It should be clear what the student is looking for in the tissue and how the tissue samples are to be processed.

When the project involves potentially dangerous chemicals, including radionuclides, insturments or techniques, specific reference should be made in this section to safety requirements observed.

When the use of electrical current, laser beams, sound stimuli or other artificial stimuli or stresses are to be integral parts of the procedure, they will not exceed the normal tissue tolerance for the species concerned and should be specifically indicated in the plan.

MAJOR DEVIATIONS FROM THE APPROVED PLAN MAY ONLY BE IMPLEMENTED WITH THE WRITTEN APPROVAL OF THE QUALIFIED SCIENTIST OR THE TEACHER-SUPERVISOR.

3. Bibliography

List the books, articles and papers thatwere read in preparation of the Research Plan. Each reference should contain the author, title of the book or paper, publisher, date ofpublication and pages used. Bibliographies comprised completely or predominantly of interviews or personal communications are unacceptable. Research involving animals must have appropriate references on animal care.

Appendix B

For projects that deal with:

Vertebrate Animal Projects

Human Subjects

Recombinant DNA

Tissues

I have enclosed the sheet of Definitions to help you.

1. Make certain you fill out your research plan carefully.

2. You may have to predate these forms where they are getting to you later than we had expected.

3. For questions on the legality and use of vertebrate animals, contact Carol McCarthy at (617) 426-9170 in the Legal Department of the Animal Rescue League.

DEFINITIONS

1. Animal - Live or preserved vertebrate and invertebrate animals, mammalian embryos and fetuses, and embryos of domesticated fowl within three days of hatching. This does not include humans.

2. Animal Care Supervisor - An individual who is knowledgeable in the proper care and handling of animals.

3. Designated Adult Supervisor - an individual who has been properly trained in the techniques and procedures to be used in the investigation and approved by the Qualified Scientist.

4. Display and Safety Committee - A group of qualified individuals which is responsible for checking compliance of exhibits with display and safety rules.

5. Human Subject - a person about whom an investigator (professional or student) conducting scientific research obtains (1) data through intervention or interaction with the person, or (2) identifiable private information.

6. Informed Consent - A signed agreement by the human subject, parent, or guardian that the proposed research and any possible risk have been defined and understood prior to participation.

7. Institutional Review Board (IRB) - Committee to review research plans involving human subjects to consider potential physical or psychological risk.

8. Qualified Scientist - An individual who possesses an earned doctoral degree in science or medicine, and who has a working knowledge of the techniques o be used by the student in the research plan.

9. Research Plan - An orderly written presentation of the proposed procedures which will be used during the research, description of the methods, techniques, and materials to be used.

10. Research Report - A final written presentation illustrating the results of library research, procedures used, data collection, analysis, and conclusion.

11. Sacrifice - Humane, painless death by approved methods.

12. Scientific Review Committee (SRC) - A group of qualified individuals which is responsible for evaluation of student research, certifications, research plans, and exhibits for compliance with the rules.

13. Supervision - Guidance by a knowledgeable adult in the planning, execution, and evaluation of student research.

14. Teacher-Supervisor - The teacher who provides educational guidance during the research process.

Research Involving State and Federal Regulations

A. Controlled Substances

(drugs, checmials, anaesthetics, etc., the use of which is regulated)

All controlled substances MUST be used according to existing local, state and federal laws. Check with you local pharmacist or for more information write your State Department of Health.

B. Lasers

Only Class I and Class II lasers may be displayed and operated at the ISEF. If a Class II laser is operated, it MUST be done under the following restrictions:

(1) The Finalist MUST be present at all times the Class II laser is operating.

(2) A sign MUST be displayed reading as follows:

"LASER RADIATION - DO NOT STARE INTO BEAM"

(3) The Class II laser MUST have a protective housing or barricade which, when in place, prevents human access to the beam during operation.

(4) The power source to the Class II laser should be disconnected when the laser is not being operated.

C. Human Subjects

All research involving human subjects MUST comply with Federal regulations. This information should be available through your Congressman or for more information write to the Office for Protection from Research Risks, National Institutes of Health, 9000 Rockville Pike, Bethesda, MD 20205.

(Tel# 301-496-7005).

The practice of medicine by students is illegal and will not be permitted without documentation of direct and complete involved supervision of a licensed professional.

D. Recombinant DNA Research

All research involving recombinant DNA technology MUST be carried out in accordance with the revised NIH Guidelines for Research Involving Recombinant DNA Molecules.

RULES FOR RESEARCH INVOLVING HUMAN SUBJECTS

A. Rationale

The Federal regulations for the protection of human subjects in behavioral and biomedical research are becoming increasingly more rigid. Technically, these regulations apply only to research funded by the Department of Health and Human Services. If students are to use human subjects they should do so in accordance with these regulations, which reflect the will of society for the protection of research subjects. It is important to indoctrinate students in proper methodology and humane concerns.

No student should be allowed to proceed on any such research unless adult supervision determines in advance that it will be in full compliance with the Federal guidelines and regulations. This includes research in which the student is the subject of his/her own research.

It is suggested that an Institutional Review Board (IRB) at the school level consist of a science teacher, an administrator, a social scientist (psychologist) and/or an MD. The IRB should review all research plans involving human subjects. Where there is no physical or psychological risk involved, an indication to that effect on the Institutional Review Board Certification #6 will be accepted.

It is important that the IRB ascertain that the student participation will not be in violation with the medical practice acts of the state in which the research is to be conducted.

B. Rules and Certifications

Documentation for research involving human subjects MUST include:

(1) Teacher-Supervisor Certification #1. For research involving human subjects this certification assures compliance with these special rules for use of human subjects.

(2) The research plan.

(3) Institutional Review Board Certification #6. This form MUST be completed by the student and approved by the IRB prior to the start of research.

(a). If the IRB determines that there is no physical or psychological risk involved in the proposal, indication to that effect on IRB Certification #6 will constitute it's approval and eliminate the need for individual Informed Consent Certifications.

(b). If the IRB determines that there are potential risks of an acceptable level involved, Informed Consent Certification #7 will be required from each subject.

(c). Only the original Informed Consent Certification #7 signed by the qualified scientist need be submitted for review by committees and judges. all other signed consent forms MUST be available from the Teacher-Supervisor.

(4) Qualified Scientist Certification #4. This certification MUST be signed by a qualified scientist indicating approval before the research is undertaken if required by the IRB. A Designated Adult Supervisor will be required when the reseearch is not conducted in the qualified scientist's laboratory.

(5) Designated Adult Supervisor Certification #5. If applicable, this certification should also be completed and signed prior to the start of research.

RESEARCH PLAN

Each Research Plan MUST provide the information as described below. This MUST be completed prior to the research.

1. Problem and Hypothesis

The student should present in this section the ideas behind the research. Why isthe research to be done? There should be a reason for wanting to do the research. some explanation should be given as to what the research is expected o show and what is to be learned. The last statements of this section should include a specific purpose of the research and an applicable hypothesis. The purpose should reflect a very close relationship with the title. Attach additional sheets if needed.

2. Methods or Procedures

Methods to be used in the research should be presented in detail. For example, if an animal or embryo is to be treated with drugs, the name of thedrug, the concentration and amount of the drug to be administered and the method of administration should be clearly outlined. It should be very clear that the student knows exactly what he or she is to do prior to the initiation of the research. If blood is to be drawn, the methods for obtaining the blood samples and the types of analyses to be carried out should be given. If tissue samples are to be taken, the methods of obtaining the tissues should be outlined. It should be clear what the student is looking for in the tissues and how the tissues are to be processed.

When the project involves radionuclides, specific reference should be made in this section to safety requirements observed.

When the use of electrical curent, laser beams, sound stimuli or other artificial stimuli or stresses are to be integral parts of the protocol, they will not exceed the normal tissue tolerance for the species concerned, as is indicated in the Biology Data Handbook - 2nd edition. Editors: P.L. Altman and D.S. Dittmer. Publisher - Federation of American Societies for Experimental Biology. Available from: FASEB, Office of Biological Handbooks, 9650 Rockville Pike, Bethesda, MD 20014.

MAJOR DEVIATIONS FROM THE APPROVED PLAN MAY ONLY BE IMPLEMENTED WITH THE WRITTEN APPROVAL OF THE QUALIFIED SCIENTIST.

3. Bibliography

List the books, articles and papers that were read in preparation of the research plan. Each reference should contain the author, title of the book or paper, publisher, date of publication and pages used. Research involving animals MUST have appropriate references on animal care.

RESEARCH PLAN

PAGES 17-18-19 MUST BE COMPLETED FOR ALL RESEARCH INVOLVING VERTEBRATE ANIMALS, HUMANS OR DNA PRIOR TO THE RESEARCH

TYPE OR PRINT

Student's name ___________________________________________________________

School _________________________________________________________________

Teacher-Supervisor's name _________________________________________________

Title Page

A. Title of research ______________________________________________

____________________________________________________________

B. Starting date of research________________________________________

C. Name and address of place where the research will be done:

____________________________________________________________

____________________________________________________________

D. Name of Animal Care Supervisor* ________________________________

E. Name of Qualified Scientist*_____________________________________

F. Name of Designated Adult Supervisor*____________________________

G. Signature of student_____________________________Date___________

* If Applicable

I certify that I have reviewed the research plan prior to the beginning of the experiments and it does comply with the Rules of the International Science and Engineering Fair.

Date ______________ Signature _____________________________________________

(Chairperson - Local Fair SRC)

MSSF

TEACHER-SUPERVISOR CERTIFICATION #1

TYPE OR PRINT

MUST BE COMPLETED FOR ALL RESEARCH INVOLVING

VERTEBRATE ANIMALS, HUMANS OR DNA

PRIOR TO THE RESEARCH

Student's name (type or print) _______________________________________________

I agree to sponsor the student named above and assume responsibility for compliance with existing International Science and Engineering Fair Rules.

Date ___________________ Signature _________________________________

Teacher-Supervisor

TYPE OR PRINT

Name __________________________________________________________________

Teacher-Supervisor

Position _________________________________________________________________

Institution _______________________________________________________________

Address _________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Office Phone ________________________

Home Address ___________________________________________________________

________________________________________________________________________

________________________________________________________________________

Home Phone ________________________

MSSF

TEACHER-SUPERVISOR CERTIFICATION #4

TYPE OR PRINT

Student's Name ________________________________________________________________

Research Title _________________________________________________________________

_____________________________________________________________________________

Scientist's Name _______________________________________________________________

Earned Degrees ________________________________________________________________

Position ______________________________________________________________________

Institution _____________________________________________________________________

Address _______________________________________________________________________

________________________________________________________ Phone ________________

Home Address __________________________________________________________________

________________________________________________________ Phone ________________

1. Animals used? yes no

2. Human Subjects used? yes no

3. Controlled substances used? yes no

If you answered yes, provide - DEA#____________ ___________________________ (Name of Substance)

a. Controlled substances were used according to existing local, state and Federal laws? yes no

4. Pathogenic agents used? yes no

a. If yes, pathogenic agents were used according to accepted procedures?

yes no

I certify that I have reviewed and approved the research plan prior to the start of the research, that if the student or designated adult supervisor is not trained in the necessary procedures I will ensure his training, that I will provide advice and supervision during the research, and that I am a qualified scientist with a working knowledge of the techniques to be used by the student in this research plan. I understand that a Designated Adult Supervisor is required when the student is not conducting his/her research in my laboratory.

Scientist's signature _______________________________________________________

(Earned Doctoral Degree (Ph.D., M.D. or D.V.M.) required

Designated Adult signature _________________________________ Date: ___________

Student's signature _______________________________________ Date: ___________

MSSF

DESIGNATED ADULT SUPERVISOR CERTIFICATION #5

TYPE OR PRINT

Student's Name ________________________________________________________________

Research Title _________________________________________________________________

_____________________________________________________________________________

I certify that I have been trained in the techniques to be used by this student prior to the start of the research and will provide direct supervision.

Signature _____________________________________ Date ___________________
DESIGNATED ADULT SUPERVISOR

TYPE OR PRINT

Name __________________________________________________________________

DESIGNATED ADULT SUPERVISOR

Position _________________________________________________________________

Institution _______________________________________________________________

Address _________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Office Phone __________________________

Home Address ___________________________________________________________

________________________________________________________________________

________________________________________________________________________

Home Phone __________________________

MSSF

INSTITUTIONAL REVIEW BOARD (IRB) CERTIFICATION #6

HUMAN SUBJECTS

MUST BE COMPLETED FOR ALL RESEARCH INVOLVING

HUMANS PRIOR TO THE RESEARCH

Student's name (type or print) _______________________________________________

School _________________________________________________________________

A

Explain why human subjects are proposed for this research: ________________________

________________________________________________________________________________________________________________________________________________

B

Describe and assess any potential risk (physical, psychological, social, legal, or other):

________________________________________________________________________________________________________________________________________________

C

Describe consent procedures to be followed (attach sample of completed form to be used):

check if not applicable ________________________________________________

________________________________________________________________________

D

Describe procedures to minimize risks _________________________________________

________________________________________________________________________ ________________________________________________________________________

E

Benefits to the individual or society ___________________________________________

________________________________________________________________________ ________________________________________________________________________

F

Describe consent procedures to be followed (attach sample of completed form to be used):

check if not applicable ________________________________________________

________________________________________________________________________

G

Approved by Institutional Review Board:

_________ No risks involved

(Teacher-Supervisor Certification #1 and Research Plan are required.)

_________ Acceptable risks involved

(All additional certifications are required, including signed consent.)

Signature ____________________________________________________________________________

Chairman of IRB

Position _______________________________________________ Date __________________________

MSSF

INFORMED CONSENT CERTIFICATION #7

Researcher's name (type or print) ____________________________________________

School _________________________________________________________________

Research Title ___________________________________________________________

A

Research procedures involving you are: ________________________________________

________________________________________________________________________________________________________________________________________________

B

Risks:

(1) Possible discomforts or risks you may reasonably expect by participation in this research

________________________________________________________________________________________________________________________________________________

(2) Procedures to be used to minimize risks

________________________________________________________________________

________________________________________________________________________

C

Possible benefits you may reasonably expect ____________________________________

____________________________________________________________________

________________________________________________________________________

D

If you have any questions regarding this research, please contact Teacher-Supervisor _________________________________________ at ____________________________

Name of Teacher-Supervisor Telephone Number

You are free to withdraw your consent and to discontinue participation in this research activity at any time without prejudice toward you.

I have read and understand the conditions stated above and consent to participate in this research procedure.

Participant's signature_______________________________ Minor (< 18) Adult

Parent's or guardian's signature (for minors) ___________________________________

This form has been approved by a Qualified Scientist

Qualified Scientist's signature ** _____________________________________________

* If the institution where the project is to be conducted has a different Informed Consent Statement that contains essentially this same information, the form of the institution will be used and will be accepted by the ISEF.

** When this form has been approved and signed by the Qualified Scientist then it should be reproduced and signed by each research participant.

MSSF

TISSUE CERTIFICATION #8

MUST BE COMPLETED FOR ALL PROJECTS USING

TISSUE, ORGANS, HUMAN PARTS, OR ANIMAL PARTS, INCLUDING BLOOD

Student's name (type or print) _______________________________________________

Student's signature ________________________________________________________

School _________________________________________________________________

Teacher-Supervisor (type or print) ____________________________________________

Teacher-Supervisor Signature________________________________________________

Tissue(s), organ(s), or part(s) used: __________________________________________

________________________________________________________________________

________________________________________________________________________

Institution or Company of Acquisition ________________________________________

________________________________________________________________________

________________________________________________________________________

I certify that the above listed materials were provided by me and that the student listed was not involved in the direct acquisition of the samples provided or purchased.

Signature ____________________________ Title _______________________________

Date ___________________





MSSF

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