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.I i ATTACHMENT 12 HEALTH AND SAFETY PLAN ACKNOWLEDGMENT AND AGREEMENT FORM (All STANTEC and subcontractor personnel must sign.) "Zero Tolerance for incident of ANY Kind. Work Together to Ensure A SAFE and High Quality Project This Health and Safety Plan has been developed for the purpose of informing STANTEC employees of the hazards they are likely to encounter on the project site, and the precautions they should take to avoid those hazards. Sub-contractors and other contractors at the site must develop their own Health and Safety Plan to address the hazards faced by their own employees. STANTEC has provided a copy of this Plan to contractors in the interest of full disclosure of hazards of which we may be aware, and to satisfy STANTEC's responsibilities under the Occupational Safety and Health Administration (OSHA) Hazard Communication standard. Similarly, contractors are required to inform STANTEC of any hazards of which they are aware or that the contractor's work on site might possibly pose to STANTEC employees, including (but not limited to) the Material Safety Data Sheets for chemicals the contractor may bring on-site_ This plan should NOT be understood by contractors to provide information on all of the hazards to which a contractor's employees may be exposed as a result of their work. further certify that I have received training and medical surveillance according to the Health and Safety Plan and the OSHA Standard on Hazardous Waste Operations and Emergency Response (29 CFR 1910.120): All parties conducting site activities are required to coordinate their activities and practices with the project Site Health and Safety Officer. Your signature below confirms that you have read and understand the hazards discussed in this Plan, and understand that sub-contractors and contractors must develop their own Health and Safety Plan for their employees. You also understand you could be prohibited by the Site Health and Safety Officer or other STANTEC personnel from working on this project for not complying with any aspect of this Health and Safety Plan. Name Title Signature Company Date STANTEC Consulting Corporation Attachment 12 I ( I 1 2 ( i I 1 t 1 I I I i 1 I