Attachment C - Safety Data Sheet.pdf
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- Solicitation number
- N6945021R0064
About this file
This document contains a safety data sheet template and information on a federal construction contract opportunity. The safety data sheet template requests safety information and insurance details for offerors to provide safety ratings for 2016 through 2020. The federal construction contract opportunity is for an Advanced Helicopter Training System compliant aircraft maintenance hangar at Naval Air Station Whiting Field in Florida. The fixed-price incentive contract requires early contractor involvement and construction of a drive-through high bay hangar optimization building with additional spaces for maintenance crews, training areas, administrative functions, data network infrastructure, and a limited food vending facility. The steel-framed structure will be built on shallow concrete foundations with exterior walls of brick veneer, insulated metal panels and translucent panels. Interior walls will consist of concrete masonry units and gypsum board on cold-formed metal studs. A low-slope standing seam metal roof and two sets of hangar doors are also included in the project scope. The contracting agency is the Naval Facilities Engineering Command within the Department of the Navy.
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Text version
N69450-21-R-0064 AHTS Aircraft Maintenance Hangar NAS Whiting Field, Florida
Revised July 2017
ATTACHMENT C – 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):
2. Insurance Carrier Information:
Insurance Carrier Name:
Agent’s name:
Phone No.:
Email:
Offeror’s Five Previous Complete Calendar Years of Reported Safety Data:
Only complete year safety data will be considered. Indicate data rates as decimal figures, not whole numbers.
3. OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate
2016 2017 2018 2019 2020
3a. If you do not have a DART Rate for a given year, affirmatively state so here and explain why:
3b. Explain any negative trend above moderate risk (DART Rates of 3.0 or greater), an acceptable/detailed explanation is required that includes any corrective actions taken for improvement:
4. Total Recordable Case (TCR) Rate
2016 2017 2018 2019 2020
4a. If you do not have a TCR Rate for a given year, affirmatively state so here and explain why:
4b. Explain any negative trend above moderate risk (TCR Rates of 4.5 or greater), an acceptable/detailed explanation is required that includes any corrective actions taken for improvement:
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