Fillable Printable Health And Safety Risk Assessment Sample Form

Health And Safety Risk Assessment Sample Form

Transfer of Copyright to

The Society for Modeling and Simulation International (SCS)

ID #:_______________

Present title of work: ______________________________________________________________________________________

_______________________________________________________________________________________________________

Author (s): ______________________________________________________________________________________________

_______________________________________________________________________________________________________

Submitted for Publication to:________________________________________________________________________________

(conference or publication name)

For SCS Conference Attendees: Upload this form with your final manuscript into the submission system.

For Other Users: Please mail, fax, or email this form back to The Society for Modeling and Simulation International (SCS)

2598 Fortune Way, Ste I, Vista, CA 92081 | Fax: 858-633-1559 | Email: scs@scs.org

Part I: The Primary Author Must Sign This Form

US Government employees whose work is not subject to US copyright should so certify by signing Part II, below.

I hereby transfer exclusively to The Society for Modeling & Simulation International (SCS) all rights granted to me by the

1. The transfer of copyright shall become effective only upon SCS’s acceptance for publication of the work.

2. The authors reserve all proprietary rights (such as patent rights) in this work other than the copyright transferred to SCS

by this document.

3. After this work has been published by SCS, the author retains the right to republish it in whole or in part in any book of

which he is an author or editor and to make personal use of this work in lectures, courses, or otherwise.

4. If the work was performed under a US Government contract or grant, SCS recognizes that the US Government has roy-

alty-free permission to reproduce all or portions of the work, and to authorize others to do so, for official US Government

purposes only, if the contract or grant requires.

5. If this work is in the public domain, such as work done for the US Government, I simply authorize its publication.

6. If this work is subject to security clearance, I certify that as of the date below it has been cleared.

I certify that this is my original work and that any references to other works are properly cited and credited.

_______________ _________________________________________________________

Date Signature of primary author

_________________________________________________________

Print name

Part II: US Government Employee Certification

Authors who are employees of the US Government are not required to sign Part I of this form, but any coauthors outside the

US Government are required to sign Part I. Authors whose work was performed under a US Government contract or grant,

but who are not Government employees, are required to sign Part I. Signing Part II certifies that ALL authors of the work

are employees of the US Government and performed this work as part of their official duties and that the work is therefore

not subject to US copyright protection.

______________ _________________________________________________________

Date Signature of primary author

_________________________________________________________

Print name