Safety & Loss Prevention

Facility Use Agreement Form

FACILITY USE AGREEMENT
UNIVERSITY OF WISCONSIN-

This is an agreement between the University of Wisconsin - __________________(Facility Owner) and _______________________ (Facility User) for the use of the _______________________ (Named Facility) facility located at ___________________________.

INSURANCE/INDEMNITY REQUIREMENTS

While using this facility, the Facility User agrees to carry a Commercial General Liability insurance policy with a limit of $1,000,000 per occurrence/$2,000,000 aggregate to cover the occurrence of property damage or bodily injury arising out of or during the use of the Facility. The University of Wisconsin provides liability protection only for its employees, officers, and agents when operating within the scope of their employment or agency.

The Facility User hereby agrees to hold harmless and indemnify the State of Wisconsin, the Board of Regents of the University of Wisconsin, and the University of Wisconsin - ______________, their officers, employees, and agents from any and all liability, loss damages, costs, or expenses which are sustained, incurred, or required arising out of the actions of the Facility User in the course of their use of the Named Facility. The Facility User also agrees to reimburse the Facility owner for any damages or costs, including clean-up, incurred to the Facility Owner arising out the use of the Named Facility.

FACILITY AND EQUIPMENT USE

The individual assigned to use the Facility must be trained on the operation of and recognize the hazards associated with the use of the Named Facility and related equipment. Prior to your occupation of the Named Facility, the facility and related equipment will be examined by ____________________ (UW Faculty responsible for oversight of this program).

The facility and equipment must be restored to the Facility Owner in the condition it was received. The Facility User is responsible for all reasonable repairs including parts and labor should malfunction or damage occur during the borrowing period.

ADDITIONAL REQUIREMENTS
  1. Any hazardous waste generated in the Named Facility by the Facility User will be properly disposed of by the Facility Owner according to State and Federal Hazardous Waste regulations. The Facility User is responsible for proper identification, segregation, and satellite storage of any waste generated by this activity. No waste shall be poured down drains or tossed in trash without approval of the Facility Owner. Any spills or injuries shall be reported to the UW Environmental Health and Safety office immediately.
  2. Each individual using the Named Facility shall wear proper personal protective equipment and handle chemicals as instructed by the UW Faculty Overseer for maximum personal protection.
  3. Facility User is responsible for compliance with WI Statute 101.58 (Employee Right to Know).
  4. Individuals using the Named Facility per this agreement must sign a Risk Awareness Agreement.
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Facility Owner Signature                                         Title                            Agency                         Date

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Facility User Signature                                             Title                           Agency                         Date