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CR Attachment A—Site Safety & Heal*-Plan <br /> Employee Acknowledgment <br /> Employee Name <br /> Project Name Project Location ProjectNumber <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 <br /> and 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 No. <br /> 2. <br /> Name of Site Safety Officer Receiving This Form <br /> Signature of Site Safety Officer Date <br /> i <br /> a <br /> BROWN and CALDWELL Forward completed form to the Heaith and Safety Director.Place a copy in project file.; HS-16Mn REV.1Z'91 <br />