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HEALTH AND SAFETY PROGRAM FOR <br /> BROWN AND Attachment A—Site Safety and Health Plan <br /> CALDWELL Employee Acknowledgment <br /> Employee Name <br /> Project Name Project Location Project Number <br /> Employee Statement of Acknowledgment <br /> I hereby certify that I have read and that I understand the safety and health guidelines contained in Brown and <br /> Caldwell's Site Safety and Health Plan for the above-named project. <br /> Employee Signature Date <br /> In the Case of an Emergency, contact: <br /> Name Relationship Phone Number <br /> 1. <br /> 2. <br /> Name of Site Safety Officer Receiving This Form <br /> Signature of Site Safety Officer Date <br /> NOTE: Send completed form to Health and Safety Director. HS-16 REV. 06/98 <br />