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Health & Safety Plan <br /> *Date, time, and names of all persons/agencies notified, and their <br /> response <br /> *Personal injury and property damage, if any. <br /> *Resolution of the incident (including duration) and the <br /> method/corrective action involved. <br /> 2. A sample accident report form is included in Appendix B. <br /> 10. ACKNOWLEDGMENT AND UNDERSTANDING OF PLAN <br /> 1. Field Personnel will be briefed as to the nature of the work at the <br /> site, potential hazards, and protective clothing requirementsrp for to site <br /> work. The personnel will then be asked to sign the following statement: <br /> This Health and Safety Plan has been explained to me. I <br /> acknowledge receipt of this Plan and obligate myself to read it. <br /> I agree to abide by the Plan and procedures outlined herein. I <br /> understand that non-compliance may lead to termination of my <br /> employment. <br /> 1. signature----- ___-- — Date– <br /> 2. Signature ------------------___--- Date <br /> 3. Signature _—_—__-- Date_____—__ <br /> 4. Signature ___— _ Date <br /> 5. Signature_-- —_— _ Date <br /> 6. Signature — _ --_—_---__— __ Date <br /> 7. Signature___ __ Date <br />