Attach 0018 DD 2357 Hazardous Component Safety Data Statement (HCSDS).pdf
PDF 1 MB Posted
- Attached to
- 5. 56mm, Jacketed Frangible, MK311 (AA40) Cartridge Federal contract opportunity
- Solicitation number
- W15QKN-22-R-0007
About this file
This document contains a federal solicitation and hazardous component safety data statement template. The solicitation seeks proposals to supply 5.56mm Semi-Jacketed Frangible Cartridge, MK311 MOD 3 (AA40) Ammunition for five years to the Office of the Project Manager for Maneuver Ammunition Systems within the Department of the Army Materiel Command Contracting Command located at Picatinny Arsenal. The ammunition will be used in M16A2 and M16A4 rifles as well as M4A1 Carbines for training purposes and to reduce collateral damage in combat. Offerors are to provide all labor and materials in accordance with the statement of work. The hazardous component safety data statement template includes sections for sensitivity testing results, hazard information, and shipping and storage classification for packed items.
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Text version
Page of
Prescribed by: DoDI 5160.68
DD FORM 2357, APR 1999
HAZARDOUS COMPONENT SAFETY DATA STATEMENT
(HCSDS)
1. DATE PREPARED
(YYYYMMDD)
2. MATERIAL/COMPONENT/ASSEMBLY 3. NUMBER 4. REVISION
5. APPLICABLE FEDERAL ACQUISITION REGULATION (FAR) SAFETY CLAUSE
PART I - SENSITIVITY (Apparatus and Comparison Values)
6. FRICTION TEST 7. IMPACT TEST 8. ELECTROSTATIC DISCHARGE TEST
PART II - HAZARDS
9. FIRE 10. AUTO IGNITION TEMP. 11. FLASH POINT 12. DECOMPOSITION PRODUCTS
13. FLAMMABLE AND/OR EXPLOSIVE LIMITS
a. LOWER PERCENT b. UPPER PERCENT
14. EXPLOSION 15. EXPLOSIVE TEMP.
(5 Sec.)
16. DUSTS
17. HEALTH HAZARD INFORMATION (Toxicity) 18. UNPACKED (In-Process) HAZARD CLASS (Specify quantities involved)
19. SPECIAL REQUIREMENTS (If additional space is needed, use plain bond paper)
PART III - SHIPPING/STORAGE CLASSIFICATION OF ITEM WHEN PACKED
IN ACCORDANCE WITH APPROVED PACKING DRAWINGS
20. DOD HAZARD CLASS/DIV 21. DOD STORAGE COMPATIBILITY
GROUP
22. DOT HAZARD CLASSIFICATION 23. DOT CONTAINER MARKING
24. PREPARED BY (Initiator)
a. TYPED OR PRINTED NAME b. SIGNATURE c. ORGANIZATION
25. CONCURRED IN BY
a. TYPED OR PRINTED NAME b. SIGNATURE c. ORGANIZATION
26. SAFETY CHIEF OR AUTHORIZED REPRESENTATIVE
a. TYPED OR PRINTED NAME b. SIGNATURE c. ORGANIZATION
The information relating to safety (herein referred to as "safety data") contained in this document is limited to those instances when the document is provided as a part of a procurement/production package which involves the development, testing, storage, manufacture, modification, renovation, demilitarization, packaging, transportation, handling, disposal, inspection, repair or any other use of the item (material/ component/assembly) which is specified in the contract. The safety data contained herein are examples which shall be used by the contractor to alert contractor personnel as well as other personnel of hazards associated with the procurement/production of the item. No representation is made that compliance with the information provided will prevent any accident to persons or property or that additional warnings may not be appropriate.
Neither the foregoing nor any act or failure to act by the Government in regard to alerting personnel to the hazards of the item shall affect or relieve the contractor of responsibility for the safety of contractor personnel or property and for the safety of the general public in connection with the performance of the contract, or impose or add to any liability of the Government for such safety.
https://www.esd.whs.mil/Portals/54/Documents/DD/issuances/dodi/516068p.pdf?ver=2018-11-16-080336-307
DRAFT
SAMPLE
DD FORM 2357, APR 1999
Page of Prescribed by: DoDI 5160.68
DRAFT
INSTRUCTIONS
NEEDS DD67
PREVIOUS EDITION IS OBSOLETE.
DD FORM XXXX, 20YYMMDD DRAFT
Page of
HAZARDOUS COMPONENT SAFETY DATA STATEMENT (HCSDS)
PART I - SENSITIVITY (Apparatus and Comparison Values)
PART II - HAZARDS
13. FLAMMABLE AND/OR EXPLOSIVE LIMITS
PART III - SHIPPING/STORAGE CLASSIFICATION OF ITEM WHEN PACKED
IN ACCORDANCE WITH APPROVED PACKING DRAWINGS
24. PREPARED BY (Initiator)
25. CONCURRED IN BY
26. SAFETY CHIEF OR AUTHORIZED REPRESENTATIVE
The information relating to safety (herein referred to as "safety data") contained in this document is limited to those instances when the document is provided as a part of a procurement/production package which involves the development, testing, storage, manufacture, modification, renovation, demilitarization, packaging, transportation, handling, disposal, inspection, repair or any other use of the item (material/component/assembly) which is specified in the contract. The safety data contained herein are examples which shall be used by the contractor to alert contractor personnel as well as other personnel of hazards associated with the procurement/production of the item. No representation is made that compliance with the information provided will prevent any accident to persons or property or that additional warnings may not be appropriate. Neither the foregoing nor any act or failure to act by the Government in regard to alerting personnel to the hazards of the item shall affect or relieve the contractor of responsibility for the safety of contractor personnel or property and for the safety of the general public in connection with the performance of the contract, or impose or add to any liability of the Government for such safety.
9.0.0.2.20120627.2.874785 DD Form 2357, "HAZARDOUS COMPONENT SAFETY DATA STATEMENT (HCSDS)"
WHS
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