Chemical Hygiene Plan

Chemical Hygiene Officer Appointment

In compliance with the Federal Laboratory Standard ______________________ (School

Name) realizes our responsibility for the protection of our employees. We hereby

institute the enclosed Chemical Hygiene Plan to assist us in our safety program.

______________________________________________(School name) hereby

appoints___________________________________(Hygiene officer’s name) to be our

Chemical Hygiene Officer. We acknowledge the Chemical Hygiene Officer has the

knowledge and authority to implement and enforce our Chemical Hygiene Plan.

Although we _________________________________________(School name) are

designating _____________________________(Hygiene officer’s name) as our Chemical

Hygiene Officer, we realize the success or lack of success of our Chemical Hygiene Plan

rests with all of our employees.

_____________________________ _____________________________

Hygiene Officer Signature

Principal Signature

_____________________________ _____________________________

Science Teacher Signature

Science Teacher Signature

_____________________________ _____________________________

Science Teacher Signature

Science Teacher Signature

_____________________________ _____________________________

Science Teacher Signature

Science Teacher Signature

_____________________________

Date

CSD Chemical Hygiene Plan

3