Appendix 0 - Attachment G - FTA Safety and Security Form.pdf
PDF 25 KB Posted
- Attached to
- RFP 225-24 Ferry Service
- Solicitation number
- BD-24-1206-MBTA-MBTA-108240
- Issued by
- Massachusetts
About this file
This document is the Federal Transit Administration's Safety and Security Reporting form for a transit service provider. The form requires the transit service provider to report monthly data on unlinked passenger trips, vehicle revenue hours and miles, vehicles operated in maximum service, major incidents such as fatalities, injuries requiring medical attention, property damage over $25,000, and evacuations, as well as non-major incidents like injuries, property damage between $7,500 and $25,000, and security incidents including Part I offenses like robbery and burglary, and Part II offenses like fare evasion and vandalism. The form must be completed and submitted monthly by the designated contact person at the transit service provider.
The form does not contain information about a specific state or local contract opportunity, but rather provides standardized reporting requirements from the Federal Transit Administration for safety and security data related to transit services. There are no details on pricing, set asides, incumbents, funding sources, or contract terms.
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Text version
FEDERAL TRANSIT ADMINISTRATION, Safety and Security Reporting
NAME OF SERVICE:
NAME OF CARRIER:
CONTACT PERSON: Phone:
Month: Year:
Mon-Fri Sat/Hol Sun/Hol Totals
Unlinked Passenger Trips
Unlinked Average Passenger Trips
Vehicle Revenue Hours
Vehicle Revenue Miles
Vehicles Operated in Maximum Service
MAJOR INCIDENT REPORTING (please circle A or B)
A) During this period, none of the following incidents occurred.
* Fatality (other than suicide). A fatality is defined as a transit-caused death confirmed within 30 days of the incident.
* Injuries requiring immediate medical attention away from the scene for two or more persons.
* Property damage equal to or exceeding $25,000. Property damage applies to all vehicles (transit and non-transit) and all property / facilities.
* An evacuation due to life safety event. A life safety event is defined as a situation such as the presence of smoke, a fuel leak, or electrical hazard, that constitutes an imminent danger.
* A collision involving a water transit vessel that results in at least one injury.
B) During this period, a major incident occurred as defined above. A report is attached.
NON-MAJOR INCIDENT REPORTING (please circle A or B)
Note: if an incident has been already reported as a "Major Incident", the information is not repeated here.
A) During this period, none of the following incidents occurred.
* An injury requiring immediate medical attention away from the scene.
* Property damage between $7,500 and $25,000. Property damage applies to all vehicles (transit and non-transit) and all property / facilities.
* Fire requiring fire personnel or suppression equipment, including fire extinguishers.
* A slip or fall on a transit vessel, or entering or leaving the vessel or on MBTA property
B) During this period, a non-major incident occurred as defined above. A report is attached.
FEDERAL TRANSIT ADMINISTRATION, Safety and Security Reporting (pg. 2)
A)
B)
NAME OF SERVICE:
NAME OF CARRIER:
Month: Year:
SECURITY REPORTING (please circle A or B)
During this period, none of the following incidents occurred.
PART 1 OFFENSES
Forcible Rape
Robbery
Aggravated Assault
Burglary / Breaking and Entering
Larceny / Theft
Motor Vehicle Theft
Arson
PART II OFFENSES
Fare Evasion
Other Assault (placing a person in fear of bodily harm through the use of threatening words and / or other conduct, but without displaying a weapon or subjecting the victim it actual physical attack)
Trespass
Vandalism
OTHER SECURITY ISSUES
Bomb threat
Chemical, biological, or nuclear release
Cyber Incident
Hijacking
Non-Violent Civil Disturbance
Property Damage
Sabotage
Suspicious Package
SUICIDE
B) During this period, an incident occurred as defined above. A report is attached.
Additional Instructions: If you have to report any of the incidences listed on this form, attach a copy of the appropriate police / insurance report. Rick Nally, from the
MBTA, is responsible for submitting this information to the FTA. He will contact you if any additional information is required.
A)
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