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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 : ii Signature : Date : This information is in case of emergency only : Social Security # : Person(s) to notify in case of Emergency : Relationship : Daytime Phone # : Name of Physician : Phone # : Medical Coverage : Employee Date of Birth : * Known Allergies : * Known Medical Conditions : I , *any known allergies or medical conditions that physicians should be made aware of before medical attention is given (i.e. allergic to penicillin ) . I I - 1 ji �