***Please modify the following safety proposal to reflect your event details. Send the completed form to Jimmy Khaw at jimkhaw@mit.edu. Any questions about event/project safety can also be sent to this email address. Once the form has been reviewed, we will contact you with any remaining questions or issues, and to let you know when the event is approved. Thanks!

Event Safety Plan: (Name of Event)

Contact Name:  		 Date:    	

Email:	 Time:    		

Phone:	 Duration:  	

Location:	 Expected # of participants:  	 

Group affiliated with this event: (Name of Group, Department, etc.)

Will this be open to individuals not affiliated with MIT?

Outline:
Event summary Objectives
Safety Concerns and Mitigation Materials
Procedure
Other Practical Considerations Diagram of Structure(s)

Key Points:
What hazards are associated with this event (risk of accident, injury, exposure, etc.)? Who will interact with these hazards?
Who will oversee safety aspects?
What safety precautions should be taken?
If outdoors, do you have an alternate weather plans?

Event Summary: Objectives:
Safety Concerns and Mitigation
Safety Concerns	Mitigation	

Materials:

Procedure:

Other Practical Considerations: Diagram of Structure(s): (If applicable)