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HEALTH AND SAFETY PLAN (HASP) <br />Acknowledgement/Agreement Form <br />(All ATC, Subcontractor & Client Personnel Must Sign) <br />Client Site Name: Project Site No. <br />ATC Project No. <br /> <br />Task No. <br /> <br />I acknowledge I have reviewed a copy of the Health and Safety Plan for this project, understand it, and agree to <br />comply with all of its provisions. I also understand I could be prohibited by the Site Health and Safety <br />Coordinator or other ATC personnel from working on this project for not complying with any aspect of this <br />Health and Safety Plan: <br />PRINT NAME SIGNATURE COMPANY DATE