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BROWN AND Attachment A--Site Safety and Health Pan <br /> CALDWELLEmployee Acknowled ment <br /> rEmployee Name <br /> r• <br /> Project Name <br /> Project Location Project Number <br /> Employee Statement of Acknowledgment <br /> I hereby Y certif that I have read and that I understand the safety and health guidelines contained in Brown <br /> and Caldwell's Site Safety and Health Plan for the above-named project. <br /> s <br /> Employee Signature Date <br /> ` In the Case of an Emergency, contact: <br /> Name Relationship Phone Number <br /> �? 1. <br /> 2. <br /> Name of Site Safety Officer Receiving This Form <br /> i Signature of Site Safety Officer Date <br /> r <br /> r <br /> LNOTE: Send completed form to Health and Safety Director. HS-16 REV. 06/98 <br />