Attachment C-Safety Data Sheet.pdf
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- Solicitation number
- N6945026R0006
About this file
This is a Safety Data Sheet template for federal contract offerors to submit safety performance information as part of their proposal evaluation.
The form requires offerors to provide five years of historical safety data (2020-2024) in the form of OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) rates and Total Recordable Case (TCR) rates, reported as decimal figures. Offerors must affirmatively explain any missing data for given years and provide detailed explanations and corrective actions for any negative safety trends, defined as DART rates of 3.0 or greater and TCR rates of 4.5 or greater. The form also requires offeror contact information and insurance carrier details including carrier name, agent name, phone number, and email address. For joint ventures or partnerships, separate Safety Data Sheets must be submitted for each contractor involved, though only one combined safety narrative is required. Subcontractor safety data (DART and TCR rates) should not be submitted.
The Technical Approach for Safety section requires a narrative not exceeding two pages that addresses the offeror's Safety Management System implementation, including management and employee involvement, hazard prevention and control, worksite analysis, and safety training with applicable benchmarking standards. Offerors must also describe their evaluation process for selecting subcontractors and detail their processes for overseeing safety compliance of subcontractors at all levels and their own in-house workforce throughout contract performance. Any pages exceeding the two-page limit will not be considered in evaluation.
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Text version
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
2020 2021 2022 2023 2024
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
2020 2021 2022 2023 2024
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:
SAFETY DATA SHEET (Continuation)
5. Technical Approach for Safety: Provide the Safety Narrative using this form. Do not exceed 2 pages. Any additional pages will not be considered.
a. Describe the Offeror’ s approach to implementing and executing a Safety Management System (SMS) including Management/Leadership involvement, Employee involvement, Hazard prevention, Hazard control, Worksite analysis, and Safety and health training, to include the standard(s) used to benchmark the SMS.
b. Describe the evaluation process used to select potential subcontractors.
c. Describe the processes of how the Offeror will oversee safety compliance of subcontractors at all levels throughout performance of the contract (to include the Offeror’s own in-house workforce).
File details come from the government source that posted it. Updated .