ATTACHMENT G - Safety Data Sheet.docx
DOCX document 16 KB Posted
- Solicitation number
- N39430-21-R-2305
About this file
This document contains a safety data sheet attachment for a federal solicitation. The solicitation is for hyperbaric systems support services to be provided to the Naval Facilities Engineering Command. The safety data sheet requests safety information from offerors, including experience modification rates, OSHA recordable incident rates, and descriptions of safety management systems and subcontractor evaluation processes. It seeks details on offerors' safety performance over the past three years as well as narratives outlining plans for monitoring workplace safety on self-performed work and at all subcontractor levels through effective prevention programs and employee reporting practices.
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| ATTACHMENT I - P463 Floor Plan.pdf | ||
| N39430-21-R-2305 Amendment 0003.pdf | ||
| N39430-21-R-2305 Amendment 0002.pdf | ||
| N39430-21-R-2305 Amendment 0001.pdf | ||
| ATTACHMENT A - Schedule of FFP Rates.xlsx | XLSX spreadsheet | |
| ATTACHMENT D - Small Business Participation and Commitment Strategy.docx | DOCX document | |
| ATTACHMENT H - Seed Task Order Performance Work Statement.pdf | ||
| ATTACHMENT E - Individual Small Business Subcontracting Plan.docx | DOCX document | |
| N39430-21-R-2305.pdf | ||
| ATTACHMENT B - Financial Questionnaire.doc | DOC document | |
| ATTACHMENT F - Small Business Subcontracting Record.docx | DOCX document | |
| ATTACHMENT C - Past Performance Questionaire.doc | DOC document |
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Text version
ATTACHMENT G – SAFETY DATA SHEET
ATTACHMENT “G”
SAFETY DATA SHEET
This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. EMR, DART, and TRC rates shall not be submitted for subcontractors.
Joint Venture (JV) or Partnership: Complete Blocks 1 through 7 for each contractor who is part of the JV or partnership. Only one safety narrative (Block 8) is required.
1. Offeror Name:
Name of JV partner providing the information below (if applicable):
Offeror’s Three 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.
| 2. Experience Modification Rate (EMR): |
| 2018 |
| 2019 |
| 2020 |
3a. For EMRs greater than 1.0, explain any extenuating circumstances and corrective actions taken:
3b. Explain any upward or downward EMR trends:
3c. If you do not have an EMR for a given year, state so here and explain why:
4. Insurance Carrier Information:
Insurance Carrier Name:
| Agent’s name: |
| Phone No.: |
| Email: |
| 5. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate |
| 2018 |
| 2019 |
| 2020 |
Instructions for calculating the DART rate can be found at http://www.bls.gov/iif/osheval.htm.
6a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:
6b. Explain any upward or downward DART Rate trends:
6c. If you do not have a DART Rate for a given year, state so here and explain why:
ATTACHMENT “G” (continuation)
SAFETY NARRATIVE
| 7. U.S. Dept. of Labor, OSHA Total Recordable Case (TRC) Rate | |
| 2018 | |
| 2019 | |
| 2020 |
Instructions for calculating the TRC rate can be found at http://www.bls.gov/iif/osheval.htm.
8a. For TRC Rates of 4.5 or greater, explain any extenuating circumstances and corrective actions taken:
8b. Explain any upward or downward TRC Rate trends:
8c. If you do not have a TRC Rate for a given year, state so here and explain why:
8. Technical Approach for Safety: Provide the Safety Narrative using this form. Do not exceed page limitation specified in the RFP. Any additional pages will not be considered.
Describe the plan that the Offeror will implement to evaluate safety performance of potential subcontractors, as a part of the selection process for all levels of subcontractors:
Describe the safety management system that the Offeror will use to oversee the safety compliance and performance of self-performed and subcontractor performed work:
ATTACHMENT “G” (continuation)
SAFETY NARRATIVE
8. Technical Approach for Safety (continuation): Provide the Safety Narrative using this form. Do not exceed page limitation specified in the RFP. Any additional pages will not be considered.
Describe any innovative methods that the Offeror will employ to ensure and monitor safe work practices at self-performed and all subcontractor levels:
Describe the methodology that the Offeror will use in order to execute an effective program that facilitates sound mishap prevention techniques and processes, employee reporting of unsafe conditions, unsafe activities, and near-miss mishaps:
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