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J <br /> VI. Approvals <br /> H & S Officer review need r this plan (See section 3): ❑ Yes ® No <br /> H & S Officer Signature s2 Date 812,q/104 <br /> Operations/ Project Manager Date <br /> VII. Acknowledgments <br /> Instructions: <br /> This form is to be signed by all on-site Foss Environmental personnel, including sub- <br /> contractors, before commencing work. Any changes to the conditions at the site or the work to <br /> be performed, requires a new Site-Specific Health and Safety Plan. <br /> Acknowledgments: <br /> I acknowledge that I have received and read the attached Site-Specific Health and Safety plan <br /> for the this project. I also certify to the best of my knowledge this plan reflects the current work <br /> to be performed and the hazards present. By signing below, I agree to abide by the all <br /> procedures and/or instructions contained in this plan and/or Foss Environmental Health & <br /> Safety Procedures and that I am ready to perform this work with the materials required. <br /> Name (print) Title Signature Date <br />