05d - Exhibit D - Safety.docx

EXHIBIT “D”

FACTOR 3 - SAFETY

SAFETY DATA SHEET

This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. DART and TRC rates shall not be submitted for subcontractors.

Joint Venture (JV) or Partnership: Provide a Safety Data Sheet for each contractor who is part of the JV or partnership; however, only one safety narrative is required.

1. Offeror Name:

Name of JV partner providing the information below (if applicable):

Instructions for calculating the DART rate can be found at http://www.bls.gov/iif/osheval.htm.

3a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:

3b. Explain any negative DART Rate trends:

3c. If you do not have a DART Rate for a given year, state so here and explain why:

Instructions for calculating the TRC rate can be found at http://www.bls.gov/iif/osheval.htm.

5a. For TRC Rates of 4.5 or greater, explain any extenuating circumstances and corrective actions taken:

5b. Explain any negative TRC Rate trends:

5c. If you do not have a TRC Rate for a given year, state so here and explain why:

Note: Form may be expanded.

EXHIBIT “D”

SAFETY NARRATIVE

Technical Approach for Safety: Provide the Safety Narrative using this form.

Do not exceed 2 pages. Any additional pages will not be considered.

6a. Describe the Offeror’s approach to implementing and executing a Safety Management System (SMS) including Management/Leadership involvement, Employee involvement, Hazard prevention, Hazard control, Worksite analysis, and Safety and health training, to include the standard(s) used to benchmark the SMS:

Note: Form may be expanded.

EXHIBIT “D”

SAFETY NARRATIVE

6b. Describe the evaluation process used to select potential subcontractors:

6c. Describe the processes of how the Offeror will oversee safety compliance of subcontractors at all levels throughout performance of the contract (to include the Offeror’s own in-house workforce):