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HEALTH AND SAFETY PLAN COMPLIANCE AGREEMENT <br /> Project Name: <br /> Project Number: <br /> I have read and understand the health and safety plan indicated above and agree to comply with <br /> all of its provisions. I understand that I could be prohibited from working on the project for <br /> violating any of the safety requirements specified in the plan. <br /> Name Signature Employer Date <br /> Form HSP-4 Page 1 of 1 <br />