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Field Team Review and Emergency Data <br /> 'il I 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 /> rr comply with all aspects of the HASP. <br /> I <br /> Name: <br /> JSignature: <br /> Date: <br /> ----------------------- <br /> This information is in case of emergency only: <br /> Social Security #: — <br /> Person(s) to notify in case of Emergency: <br /> I_ <br /> Relationship: <br /> II <br /> _ Daytime Phone #: <br /> Name of Physician: Phone #: <br /> Ii <br /> Medical Coverage: <br /> EmployeeDateof 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 /> it <br /> I <br />