Safety Acknowledgment Form

For more information about NMR safety or a more detailed explanation of the guidelines and rules, please ask Ata Shirazi before turning in this completed form. I hereby acknowledge that I have read, understand and agree to observe the safety guidelines when working in the UCSB Department of Chemistry and Biochemistry NMR Facility. I also understand that violation of the safety guidelines or Facility rules may result in the termination of my user privileges. USER: _____________________________________ SIGNATURE: _______________________________ DATE: _______________ SUPERVISOR: ______________________________ SIGNATURE: _______________________________ DATE: _______________

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The NMR Facility Manager can be reached at shirazi@chem.ucsb.edu