A005 ACCIDENT INCIDENT REPORT SAFT-81563.pdf
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- Attached to
- C-5 MLG Trunnion Bearing
- Solicitation number
- FA8538260019
About this file
This is a DD Form 1423-1, Contract Data Requirements List (CDRL), specifying a single data item requirement for contract FD2060-27-00013 with TRUNNION BEARING as the system/item.
The required data item is the Accident Incident Report (Data Item No. A005) with the subtitle "Mishap Notification/Investigation." The data item is authorized under DI-SAFT-81563 and references PWS Paragraph 5.5.2. The requiring office is ABW/SE. Submission is required once assets have been received after contract award, and subsequent submissions must be made within 24 hours after any accident or incident occurs, as needed per IAW AFI 91-207. The report must be submitted in digital copy format (Microsoft Office or Adobe Portable Document Format) to the Safety Office at AFLCMC.SES.RobinsSafeSys@us.af.mil. The contractor's Point of Contact (POC), Program Manager, and Engineer will be provided at contract award. Distribution requirements specify that digital copies are to be provided in Draft and Final formats as regulated for reproduction. The form was prepared by GRINSTEAD.JESS on 3/20/2026 and approved by LISTER.WESLE on 3/20/26.
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DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No.
listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:
TDP ________ TM _______ OTHER
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
16. REMARKS (Continued)
Page of Pages
A_CONTRACT_LINE_ITEM_NO:
B_EXHIBIT:
xTDP: Off xTM: Off
OTHER:
DSYSTEMITEM:
E_CONTRACTPR_NO:
FCONTRACTOR:
16_REMARKS_Continued: s. Original drawings are not required. If applicable, reproducible stable base copies of unidimensional drawings and master pattern drawings are required. See Block 14.
Page2: 2 of_pages:
Reset:
| xtm: Off |
| 1_DATA_ITEM_NO: A005 |
| 2_TITLE_OF_DATA_ITEM: Accident Incident Report |
| 3_SUBTITLE: Mishap Notification/Investigation |
| 4_AUTHORITY_Data_Acquisit: DI-SAFT-81563 |
| 5_CONTRACT_REFERENCE: PWS Paragraph 5.5.2 |
| 6_REQUIRING_OFFICE: ABW/SE |
| 7_DID_250_REQ: N/A |
| 8_APP_CODE: N/A |
| DIST_STATEMENT: B |
| 10_FREQUENCY: SEE BLK 16 |
| 11_AS_OF_DATE: SEE BLK 16 |
| 12_DATE_OF_FIRST_SUBMISSI: SEE BLK 16 |
| 13_DATE_OF_SUBSEQUENT_SUB: SEE BLK 16 |
| addressee1: SEE BLK 16 |
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| 16_REMARKS: Exhibit Data Item No Performance Period |
A A005 Base Year Period B B005 Ordering Period 1 C C005 Ordering Period 2 D D005 Ordering Period 3 E E005 Ordering Period 4
NOTE: Changes to office symbols and/or e-mail addresses, when necessary, shall be made by letter through the Government CO/ACO without further revision to this CDRL.
BLK 10: IAW AFI 91-204, if damage occurs
BLK 11: Once assets have been received after contract award
BLK 12: Within 24 hours after accident/incident occurs
BLK 13: As needed, IAW AFI 91-207
BLK 14:Submit a digital copy in Microsoft® Office® or an Adobe® Portable Document Format (PDF) format to the following email Addresses:
Safety Office: AFLCMC.SES.RobinsSafeSys@us.af.mil Program Manager: POC will be given at contract award Engineer: POC will be given at contract award
| 17_PRICE_GROUP: NSP | |
| ESTIMATED_TOTAL_PRICE: | |
| H_DATE: 3/20/2026 | |
| J_DATE: 3/20/26 | |
| Page: 1 | |
| reg38t: 0 | |
| A_CONTRACT_LINE_ITEM_NO: | |
| B_EXHIBIT: A-E | |
| xTDP: Off | |
| OTHER: X | |
| DSYSTEMITEM: C5 TRUNNION BEARING | |
| E_CONTRACTPR_NO: FD2060-27-00013 | |
| FCONTRACTOR: | |
| of_pages: 1 | |
| Reset: | |
| 2026-03-20T15:12:45-0400 | |
| GRINSTEAD.JESSICA.M.1610582822 |
| 2026-03-23T08:22:18-0400 | |
| LISTER.WESLEY.A.1394566558 |
File details come from the government source that posted it. Updated .