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Field Team Review and Emergency Data <br /> I have read and reviewed the most recent revision <br /> Date <br /> of the Health and Safety Plan ( HASP) for the <br /> Project <br /> I understand the information contained therein and will <br /> Site <br /> comply with all aspects of the HASP . <br /> Name : <br /> Signature : <br /> Date : <br /> This information is in case of emergency only : <br /> Social Security # : <br /> Person (s) to notify in case of Emergency : <br /> Relationship : <br /> Daytime Phone # : <br /> Name of Physician : Phone # : <br /> Medical Coverage : <br /> Employee Date of Birth : <br /> * Known Allergies : <br /> * Known Medical Conditions : <br /> *any known allergies or medical conditions that physicians should be made aware of before <br /> medical attention is given (i . e, allergic to penicillin). <br />