ATTACHMENT D Safety Data Sheet.docx
DOCX document 15 KB Posted
- Attached to
- 8(a) Small Business Multiple Award Construction Contract Federal contract opportunity
- Solicitation number
- N4008019R0001
About this file
This document contains a safety data sheet template and information about a related federal contract opportunity for construction services. The safety data sheet template requests experience modification and OSHA recordable case rates for the past three years, and requires explanations for any rates above thresholds or negative trends. It also relates to an 8(a) small business multiple award construction contract with the Naval Facilities Engineering Command to provide new construction, repair, and renovation services at various facilities in Washington, Maryland and Virginia. The solicitation number and opportunity type are provided, along with the contracting agency.
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Text version
ATTACHMENT D
SAFETY DATA SHEET
1. Respondent:
Most Recent Complete Calendar Years of Reported Safety Data:
Indicate data rates as decimal figures, not whole numbers.
| 2. Experience Modification Rate (EMR): |
| Year-20XX |
| Year-20XX |
| Year-20XX |
2a. For EMRs greater than 1.0, explain any extenuating circumstances and corrective actions taken:
2b. Explain any negative EMR trends:
2c. If you do not have an EMR for a given year, state so here and explain why:
| 3. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate |
| Year-20XX |
| Year-20XX |
| Year-20XX |
Instructions for calculating the DART rate can be found at http://www.bls.gov/iif/osheval.htm.
3a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:
3b. Explain any negative DART Rate trends:
3c. If you do not have a DART Rate for a given year, state so here and explain why:
Note: Form may be expanded.
(continuation)
SAFETY NARRATIVE
| 4. U.S. Dept. of Labor, OSHA Total Recordable Case (TRC) Rate | |
| Year-20XX | |
| Year-20XX | |
| Year-20XX |
Instructions for calculating the TRC rate can be found at http://www.bls.gov/iif/osheval.htm.
4a. For TRC Rates of 4.5 or greater, explain any extenuating circumstances and corrective actions taken:
4b. Explain any negative TRC Rate trends:
4c. If you do not have a TRC Rate for a given year, state so here and explain why:
File details come from the government source that posted it. Updated .