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i <br /> AffIchment A—Site Skkty & Health Plan <br /> Employee Acknowledgment <br /> i <br /> Employee Name <br /> Projea Name Projea Location Projea Number <br /> Employee Statement of Acknowledgment <br /> i hereby certify 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 /> i <br /> i <br /> i <br /> i <br /> I <br /> Employee Sigmtum Date <br /> to the Case of an Emergency, ct)ntaa:: <br /> Name Relationship Phone No. <br /> L <br /> 2 <br /> I <br /> Name of Site Safety Officer Receiving This Form <br /> Signature of Site Saiety Officer Date <br /> i <br /> i <br /> I <br /> a <br /> I <br /> I <br /> aao�. "O%tu Forward completed form to the Health and Safer Director.Place a copy in project file. <br />