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Field Team Review and Emergency Data <br /> I have read and reviewed the most recent revision <br /> Date <br /> of the Health and Safety Plan (HASP) for the <br /> Project <br /> I understand the information contained therein and will <br /> Site <br /> � comply with all aspects of the HASP. <br /> f <br /> Name: <br /> ------------------------------ <br /> ` Signature: <br /> ...... .................. <br /> ` Date: <br /> ----------------------------- <br /> This information is in case of emergency only: <br /> Social Security #: <br /> II - Person(s) to notify in case of Emergency: <br /> I <br /> j l Relationship: <br /> Daytime Phone #: <br /> j l Name of Physician: Phone #: <br /> _ Medical Coverage: <br /> r] Employee Date of Birth: <br /> *Known Allergies: <br /> *Known Medical Conditions: <br /> *any known allergies or medical conditions that physicians should be made aware of before <br /> medical attention is given (i.e. allergic to penicillin). <br /> L <br /> LI <br />