HASP/EAP Acknowledgment Form Form 09: HASP/EAP Acknowledgement Form Please complete this form to acknowledge that you have received the Health and Safety documentation and that you will adhere to the guidelines for your production. Production Name Name First Last Job Title Department Department Supervisor I understand and acknowledge: If I am a Supervisor, I accept the safety responsibilities as outlined in Federal/State Laws and the Company's Health & Safety Plan. I have received, read, and will abide by the Health & Safety Plan (HASP) for Production and the COVID-19 Protocols. I understand that failure to adhere to these guidelines may result in disciplinary action, including dismissal. The Company also has an Injury & Illness Prevention Program (IIPP). It can be found in the Production Safety Manual, Production Office, Construction Office, on-set with the 1st A.D, or online at https://foxsafety.com/. I will see my Supervisor or call EHS at (310) 369-2671 or send an email to safety@fox.com, if I have questions or safety concerns. If I have an injury, I will report to the Set Medic or my Supervisor or the Fox Incident Hotline at (866) 369-2225. If I am injured or feel ill for any reason, I will notify my Supervisor and/or Set Medic immediately. I will wear appropriate clothing, shoes, and Personal Protective Equipment (PPE) recommended by my Supervisor, the Production Safety Rep, the COVID Compliance Officer, or the COVID-19 Protocols. If I have any COVID-19 related concerns or questions, I can raise them with the COVID Compliance Officer, my supervisor, the EHS Rep, or report them to the Anonymous Safety Hotline. This production has a strict fall protection policy. If I am not trained to work at heights, I will NOT work at heights. This Production has a strict table saw use policy. I will ALWAYS use the saw guard, as authorized by my supervisor. I will NOT operate any machinery that is not in good working order. Any deficiencies I notice will be brought to the attention of my supervisor. I will NOT perform any potentially hazardous activity that I have not been trained to do. I can request a copy of a Material Safety Data Sheet (MSDS) for any product at (888) 362-7416 or online at www.FOXsafety.com/202-2. The HASP offers general safety advice for construction or production. More detailed safety information is available at www.foxsafety.com and/or from the Production Safety Rep. I must attend safety meetings as instructed by my supervisor or whenever they are appropriate for my work. SignatureBy signing this form you do not waive any of your rights under Workers’ Compensation laws.Date MM slash DD slash YYYY Δ