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