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Name Date Signature Company All Stantec and subcontractor personnel must sign. SITE-SPECIFIC HEALTH AND SAFETY PLAN FOR WELL INSTALLATIONS May 4, 2017 Acknowledgement and Agreement Form "Zero Tolerance for Incidents of ANY Kind. Work Together to Ensure A SAFE and High Quality Project" This HASP has been developed for the purpose of proactively aiding Stantec employees in identifying, understanding, and mitigating the risks/hazards they are likely to encounter at the site. This HASP may also be used as a guidance document by properly trained and experienced Stantec subcontractors and clients; Stantec is readily available to assist subcontractors in identifying and addressing their employees' risks; however, sub-contractors and other contractors at the site must develop their own HASP to address the hazards faced by their own employees. All parties are required to review Attachment 2, Preventing Serious Injury & Fatalities Field Guide prior to commencing work. All parties conducting site activities are required to coordinate their activities and practices with the Stantec Site Health and Safety Officer (SHSO). Stantec has provided a copy of this HASP to contractors in the interest of full disclosure of hazards of which we may be aware and to satisfy Stantec's responsibilities under the Occupational Safety and Health Administration (OSHA) Hazard Communication standard. Similarly, contractors are required to inform Stantec of any hazards of which they are aware or that the contractors work on site might possibly pose to Stantec employees including (but not limited to) the Safety Data Sheets (SDS) for chemicals the contractor may bring on site. This HASP should NOT be understood by contractors to provide information on all of the hazards to which a contractors employees may be exposed as a result of their work. Stantec claims no responsibility for use of this HASP by others for purposes unrelated to this project. Your signature below confirms the following: you have read and understand the hazards and associated mitigation measures discussed in this HASP; you have received training and medical surveillance according to this HASP and the OSHA Standard on Hazardous Waste Operations and Emergency Response (29 CFR 1910.120), as applicable; you understand that sub-contractors and contractors must develop their own HASP for their employees; and you understand that you could be prohibited by the SHSO or other Stantec personnel from working on this project for not complying with any aspect of this HASP. Stantec