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k <br />LOCKOUT TAGOUT POLICY AND PROCEDURE <br />livi ng Cei" ters <br />Attachment "D" <br />FACILITY NAME <br />Outside Contractors' Policy and Procedures for Hazard <br />Communication and Lockout/Tagout <br />Contractor Acknowledgement Form <br />I have reviewed and understand the facility's Hazard Communication policy and procedure on <br />the handling, containment, and use of hazardous chemicals. I understand that all hazardous <br />chemicals at the facility have an issued material safety data sheet (MSDS), which is available in <br />the areas where these chemicals are stored and used. I agree to make a MSDS available to facility <br />staff at all times for any chemical, which I bring to the facility. I am also aware that the facility <br />has a container labeling system and that all containers for hazardous chemicals must be <br />appropriately labeled. I understand that the facility has an emergency response procedure should <br />a hazardous material incident occur. <br />I have also reviewed and understand the facility's lockout/tagout policy and applicable <br />procedures and agree to comply with all aspects of these procedures. <br />Signature of Contractor <br />Date <br />Signature of Facility Representative <br />Date <br />Golden Living LOCKOUTITA BOUT Page 10 of 10 <br />