Acknowledgment Form

I, ___________________________________________, am a student/user of the Energy Systems Laboratory (DU 31 and 33) at Kansas State University. I acknowledge receipt of a copy of the following:

Safety Tips for Energy Systems Laboratory,

Safety Alert on Hazardous Conditions Related to Soft Contact Lenses,

The Fatal Current, and

Fire

I further acknowledge that I have read the same and that I have had an opportunity to ask questions regarding any parts of same which were unclear to me. I have also read the Safety Rules and Suggestions from the EECE 589 Laboratory manual written by Dr. Johnson. I agree to abide by the requirements set forth for safe practices in the laboratory.

________________________________________
Student/User

Date: _________________________