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ATTACHMENT A <br /> • SAFETY COMPLIANCE AGREEMENT FORM <br />' Site: <br />' Project No,: <br /> I the undersigned, acknowledge that I have attended the safety meeting, and received a copy of <br />' this site-specific safety plan I have read and understood the safety plan, and do agree to adhere <br /> to the requirements specified by it I understand that I may be prohibited from continuing work <br /> on the project for failing to comply with this safety plan <br /> Signature Company Date <br /> (Print name below) <br /> 1 <br /> 1 <br /> I <br /> Meeting Conducted by- <br /> Signature <br /> • Pie Lcamer Company Health&Safety Flan <br /> P"%—c uvkp97016\97016 hsp'Rc% 0 Oune 19Q7) <br /> �y <br /> I Y v <br />