Attachment 0016 - Request for Use of Prohibited Material.docx
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- Solicitation number
- W56HZV21R0185
About this file
This document contains a template request form for seeking approval to use prohibited materials on a federal contract for a Cold Weather All-Terrain Vehicle (CATV). The form requests information on the proposed use of prohibited materials, including explanations of the use, associated health hazards, analysis of alternative materials, technical justification, program risks if denied, and a get well plan. It also includes sections for an Environmental Safety and Occupational Health representative evaluation and recommendation, and executive concurrence and approval. If approved, the prohibited materials could be used to fulfill a requirements contract for production units, spare parts, and contractor logistics support for CATVs. The contract is valued at $56 million and would be awarded by the Department of the Army Materiel Command TACOM Life Cycle Management Command to a single contractor for an initial period of five years with two optional one-year extensions, for a potential total period of seven years.
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UNCLASSIFIED
Attachment 0016 – Request for Use of Prohibited Material
Attachment 0016
Request for Use of Prohibited Material
Distribution Statement A – Approved for Public Release; distribution unlimited
(*Distribution Statement A only applies when form is not filled in. Once filled check the [Program] Security Class Guide for proper distribution statement/markings)
1. General Information
Requesting Company
Date of Request
Point of Contact
Prohibited material for which waiver is requested
2. Explanation of Use
Instructions: Provide a description of the parts/processes where the prohibited material will be used. Identify all components/parts which will contain the prohibited materials upon vehicle delivery including quantities of these parts. Indicate the specific variant and/or trailer the components/parts are on. Identify whether or not the material will be required for operation or maintenance (including during vehicle rebuild). A separate spreadsheet may be attached listing the specific parts/processes, if needed.
3. Health Hazard
Instructions: Provide an explanation of any health hazards associated with the use or presence of the prohibited material. Include likely routes of exposure to both the operator and the maintainer. Identify if any personal protective equipment (PPE) that would be required as a result of using this material. Include the type of PPE and under what circumstances it would be required (manufacturing, operation, maintenance, etc.).
4. Analysis of Alternatives
Instructions: Identify all alternative which were considered for the prohibited material. If the alternative is only for specific applications, identify what type of parts it is a potential alternative for.
5. Technical Justification
Instructions: Provide technical justification for the use of prohibited material. Explain why it is necessary and why it cannot be eliminated. Note cost, schedule, and use of non-developmental items (NDI) are not technical justifications.
6. Program Risk
Instructions: Describe the program risk(s) (cost, schedule, and performance) associated with denial of this request by the Government.
7. Get Well Plan
Instructions: Identify which parts where an alternative may be integrated at a later date. Provide a get well plan explaining how this will be accomplished. Also, indicate which parts you will not be able to eliminate and provide a brief explanation.
The following Sections will be filled in by the Government
8. Environmental Safety and Occupational Health Representative Evaluation/ Recommendation
Instructions: Government ESOH Representative to provide evaluation of the above information and a recommendation to the Product Director/Project Manager regarding approval/disapproval of the prohibited material request.
ESOH Representative Date
9. Concurrence
I concur that use of {prohibited material} as described in this form under the {Contractor Name} Contract –{Contract Number} is acceptable and justified:
Chief/Lead Engineer
Product Director
10. Approval
Upon the basis of the findings above, I hereby determine that use of {prohibited material} as identified in Section 2 of this form for the {Contractor Name} Contract {Contract Number} is acceptable and justified.
Project Manager
UNCLASSIFIED
File details come from the government source that posted it. Updated .