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BROwN AND Attachment A—Site Safety and Health Plan <br /> ALDWELL Employee Acknowledgment <br />' Employee Name <br />' Project Name Project Location Project Number <br /> Employee Statement of Acknowledgment <br /> I herebycertify that I have read and that I understand the safety and health guidelines contained in Brown <br /> Y Y <br /> and Caldwell's Site Safety and Health Plan for the above-named project <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 />' Signature of Site Safety Officer Date <br /> i <br /> NOTE Send completed form to Health and Safety Director HS---16 REV 06/98 <br />