B08 Exhibit H - PM-12 KTR Accident Reporting Format.xlsx

XLSX spreadsheet 38 KB Posted

Attached to
EAGLE Fort Cavazos, TX W519TC-23-R-0102
Solicitation number
W519TC23R0102
Issued by

About this file

Written by GovTribe AI ·

This document appears to be a template or form for reporting accidents or incidents related to a federal contract. It includes fields for capturing details such as the date, location, type, and causes of the incident, as well as information about any injuries, property damage, and corrective actions taken. The form also includes a lookup table of valid UICs (Unit Identification Codes) associated with different Army organizations and locations.

The related federal contract opportunity is for maintenance, supply, and transportation services at Fort Cavazos, TX, with a solicitation number of W519TC-23-R-0102. This is a solicitation being issued by the Department of the Army Materiel Command Contracting Command Rock Island Arsenal.

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File Type Posted
B08-Attachment 0039- Ft. Cavazos Q&A responses round 5.xlsx XLSX spreadsheet
W519TC23R0102-0009.pdf PDF
B08 Attachment 0004 - Letter of Consent_FCTX-REV1.pdf PDF
B08 - Attachment 0038- Ft. Cavazos Q&A responses round 4.xlsx XLSX spreadsheet
W519TC23R0102-0008.pdf PDF
B08 Attachment 0036- Ft. Cavazos Q&A Responses Round 2.xlsx XLSX spreadsheet
W519TC23R0102-0007.pdf PDF
B08 - Attachment 0037- FT. Cavazos Q&A responses round 3.xlsx XLSX spreadsheet
W519TC23R0102-0006.pdf PDF
W519TC23R0102-0004.pdf PDF
W519TC23R0102-0003.pdf PDF
Attachment 0035- Ft. Cavazos Q&A Responses Round 2.xlsx XLSX spreadsheet
FCTX QA Round 02_26JUN2024 - FOR OFFERORS.xlsx XLSX spreadsheet
B08 Attachment 0011 - Contract References Spreadsheet_18JUN24.xlsx XLSX spreadsheet
B08 Attachment 0001 - Performance Work Statement - PWS 24JUN2024.pdf PDF
W519TC23R0102-0002.pdf PDF
B08-Attachment 0001- Performance Work Statement - PWS 30MAY2024.pdf PDF
B08-Attachment 0035- Ft. Cavazos Q&A Responses_10JUN2024.xlsx XLSX spreadsheet
B08-Attachment 0031- Appendix C Red Hat 30MAY2024.docx DOCX document
B08-Attachment 0005 - Cost Price Matrix-Cavazos 03JUN2024.xlsx XLSX spreadsheet
B08-Attachment 0030- Appendix B Phantom SSA 30MAY2024.docx DOCX document
W519TC23R0102-0001.pdf PDF
B08-Attachment 0033- Appendix E PAAT 30MAY2024.docx DOCX document
B08-Attachment 0034- Appendix F 3SFAB 30MAY2024.docx DOCX document
B08-Attachment 0032- Appendix D FSR 30MAY2024.docx DOCX document
B08 Exhibit E - MMD-01 Maintenance Report Format.xlsx XLSX spreadsheet
B08 Attachment 0010 Blocked File Extensions_with updated DoDAAC (1).pdf PDF
W519TC23R0102.pdf PDF
B08 Exhibit J - SS-01 Supply and Services Report Format.xlsx XLSX spreadsheet
B08 Attachment 0008 - NOT APPLICABLE.pdf PDF
B08 Attachment 0014 - Small Business Participation Plan.docx DOCX document
B08 Attachment 0001 - Performance Work Statement - PWS 20240307.pdf PDF
B08 Attachment 0006 - Preaward Survey of Prospective Contractor Accounting System SF 1408.pdf PDF
B08 Attachment 0016 - PWS Annex A Maintenance PRS 20240301.pdf PDF
B08 Exhibit A - dd1423-1.pdf PDF
B08 Exhibit G - PM-09 Performance Management Review Format (version 3-04-24).pptx PPTX presentation
B08 Attachment 0020 - PWS Annex E - Definitions Acronyms Abbreviations.pdf PDF
B08 Attachment 0009 - Purchasing Invoicing Guide (PIG) FCTX.pdf PDF
B08 Attachment 0018 - PWS Annex C Transportation PRS 20240301.pdf PDF
B08 Attachment 0005 - Cost Price Matrix-Cavazos.xlsx XLSX spreadsheet
B08 Attachment 0002 - Staffing and Labor Mix 7MAR24.xlsx XLSX spreadsheet
B08 Attachment 0004 - Letter of Consent_FCTX.pdf PDF
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B08 Attachment 0022 - PWS Appendix A MDRS 20240229.pdf PDF
B08 Attachment 0021 - PWS Annex F - Publications and Forms.pdf PDF
B08 Exhibit D - ITD-01 Transportation Report Format.xlsx XLSX spreadsheet
B08 Attachment 0011 - Contract References Spreadsheet_FCTX.xlsx XLSX spreadsheet
B08 Attachment 0003 - Performance Questionnaire_FCTX.pdf PDF
B08 Attachment 0029 Government Responses to Industry FCTX.xlsx XLSX spreadsheet
B08 Exhibit F - PM-01 Contractor Employee Information Format.xlsx XLSX spreadsheet
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Main

Contractor Injury/Mishap Report and/or Property Damage

All Blocks Are RequiredKeyDrop Down MenuAuto Populated
1POC Email Address
2COR Email Address
3/27/243Today's Date
4Mishap Date
5UIC
Enter Valid UIC in Block 56Brigade
Enter Valid UIC in Block 57Battalion
Enter Valid UIC in Block 58LRC
9Where Exactly Did This Accident/Mishap Occur?
10Accident Type
11Accident Context
12Category
13Days in Hospital In-Patient
14Days of Lost Time
15Days of Restricted Work
16Injury/Illness Type
17Cause of Injury
18Body Area
19Specific Body Part
20Attributable Factor
21If Human Error
22What Was Damaged
23Estimated Cost of Damage
24Who/What was Injured/Damaged
What happened
NarrativeWhere did this occur
When did this happen
Why did this happen
25Corrective Actions Taken or Will Take To Prevent This From Happening Again
UIC Table Start
W0DAAAHQ ASCHHCN/A
W0DA6BHQ ASCJPPSO-MAN/A
W0DA4GHQ ASCJPPSO-NWN/A
WJN799401N/AN/A
W0DA49401AFSBn QatarN/A
W0DA51401AFSBn KuwaitN/A
W0DAG7401AFSBn-SWA WEB KuwaitN/A
W0DAH7401AFSBn-AfghanistanN/A
W0DA55401AFSBn SWAN/A
WJN899402N/AN/A
W6XPAA402AFSBn HAWAIIN/A
W6XP01402N/ALRC Hilo (PTA)
W6XSAA402AFSBn ALASKA (LRC JBER)N/A
W6XS01402N/ALRC GREELY
W6XS02402N/ALRC WAINWRIGHT
WJN999403N/AN/A
W6XGAA403N/ALRC Daegu
W6XHAA403AFSBn KoreaN/A
W6XH01403N/ALRC Yongsan
W6XH02403N/ALRC Red Cloud
W6XJAA403N/ALRC Camp Zama
W6XKAA403N/ALRC Torii Station
W0DA52403AFSBn NEAN/A
W0DAC6403AFSBn NEA FWD WEB YOKOHAMAN/A
W0DA53403AFSBn NEA FWD/LST SAGAMIN/A
WJP199404N/AN/A
W6WTAA404N/ALRC Aberdeen Proving Ground (& EA)
W6X8AA404N/ALRC Adelphi
W6WRAA404N/ALRC Detroit Arsenal
W6XCAA404N/ALRC Devens
W6XFAA404N/ALRC Hunter Liggett
W6XRAA404N/ALRC Irwin
W6X9AA404N/ALRC McCoy
W6WVAA404N/ALRC Natick (Soldier Support Center)
W6WUAA404N/ALRC Picatinny Arsenal
W6YFAA404N/ALRC Polk
W6WQAA404N/ALRC Redstone Arsenal
W6WSAA404N/ALRC Rock Island Arsenal
W6XBAA404N/ALRC JB McGuire-Dix
W6YXAA404N/ALRC JB Lewis McChord (JBLM)
W6YX01404N/ALRC Yakima Training Center
W0DA30404AFSBn CHARLESTON (ASLAC)N/A
WJP299405N/AN/A
W6XUAA405N/ABASOPS
W6Y8AA405N/ALRC Ansbach
W6Y0AA405N/ALRC Baumholder
W6Y1AA405N/ALRC Bavaria (Graf)
W6XVAA405N/ALRC Benelux
W6XWAA405N/ALRC Brussels
W6Y3AA405N/ALRC Garmisch
W6Y4AA405N/ALRC Hohenfels
W6Y5AA405N/ALRC Italy (Vicenza)
W6Y6AA405N/ALRC Livorno
W6XZAA405N/ALRC Rheinland Pfalz (Ktown)
W6XXAA405N/ALRC Schinnen
W6XYAA405N/ALRC Stuttgart
W6Y7AA405N/ALRC Wiesbaden
W0DAN5405AFSBn GermanyN/A
W0DAP4405BLSE CAB 12 ID KATTERBN/A
W0DAC9405BLSE SBCT 2ND CR VILSECKN/A
W0DA45405AFSBn AfricaN/A
W0DAB6405LST AfricaN/A
W0DAV8405BLSE 173RD VICENZAN/A
W0DA24405AFSBn Benelux (Eygelshoven)N/A
W0DA8M405APS 2 ZutendaalN/A
W0DA88405APS 2 DulmenN/A
W0DAN6405AFSBn MannheimN/A
WJP399406N/AN/A
W6WXAA406N/ALRC AP Hill
W6WWAA406N/ALRC Belvoir
W6YGAA406N/ALRC Benning
W6X2AA406N/ALRC Carlisle Barracks
W6WYAA406N/ALRC Detrick
W6YHAA406N/ALRC Gordon
W6XAAA406N/ALRC Hamilton
W6YMAA406N/ALRC Jackson
W6YCAA406N/ALRC Lee
W6WZAA406N/ALRC Meade
W6YJAA406N/ALRC Rucker
W6X1AA406N/ALRC West Point
W6YLAA406N/ALRC Hunter Army Airfield
W6YNAA406N/ALRC Joint Base Langley-Eustis
W6X0AA406N/ALRC Joint Base Myer-HH
W6YBAA406AFSBn BraggN/A
W6YDAA406AFSBn CampbellN/A
W6YEAA406AFSBn DrumN/A
W6YKAA406AFSBn StewartN/A
WJP499407N/AN/A
W6XDAA407N/ALRC Buchanan
W6YVAA407N/ALRC Knox
W6YTAA407N/ALRC Leonard Wood
W6X3AA407N/ALRC Leavenworth
W6XEAA407N/ALRC Miami
W6YWAA407N/ALRC Sill
W6YSAA407N/ALRC JB San Antonio
W6YS01407N/ALRC SotoCano
W6X5AA407N/ALRC White Sands Missile Range
W6X4AA407N/ALRC Presidio
W6X6AA407N/ALRC Yuma Proving Ground
W6X7AA407N/ALRC Dugway Proving Ground
W6XQAA407N/ALRC Huachuca
W6YPAA407AFSBn BlissN/A
W6YQAA407AFSBn CarsonN/A
W6YRAA407AFSBn HoodN/A
W6YUAA407AFSBn RileyN/A
UIC Table End
Accident Type Start
Property Damage
Fatality
Injury/Illness That Causes 1 Day Away From Work or More Past Occurance
Injury/Illness That Causes Work Restriction/Job Transfer
Contaminated Needle Stick/Sharp
Work Related Turbuculosis
Medical Treatment Beyond First Aid
Occupational Hearing Loss
First Aid Only
Near Miss
Accident Type End
Accident Context Start
Maintenance
Warehouse
Shop Floor
Dining Facility
Army Tactical Vehicle
Non-Tactical Vehicle
Private Motor Vehicle
Material Handeling Equipment
Pedestrian
Railhead
Watercraft
N/A
Accident Context End
Category Start
Exposure
Vehicular
Other
Caught In/Under/Between-Struck By/Against
Slip/Trip/Fall
Bodily Reaction
Category End
Injury/Illness Type Start
Abrassions
Amputation - No Bone
Amputation - With Bone
Asphyxiation
Burns (Chemical)
Burns (Thermal)
Decompression Sickness (Bends)
Contusion
Concussion
Cuts/Laceration
Dislocation
Fractures
Frostbite
Heat Exhaustion
Heatstroke
Hernia/Rupture
Loss of Consciousness
Noise Injury
Puncture Wound
Rash
Sprains/Strains
Swelling
N/A
Injury/Illness Type End
Cuse of Injury Start
Bodily Reaction
Caught In/Under/Between
Exposure
External Contact
Fell From Elevation
Fell From Same Level
Ingested
Inhaled
Occupational Illness/Injury
Overexertion
Rubbed/Abbraded
Struck Against
Struck By
Thrown From
N/A
Cause of Injury End
Body Area Start
AreaBodyHeadNeckUpperTrunkLowerN/A
BodyGeneralGeneralGeneralGeneralGeneralGeneralN/A
HeadEar(s)ThroatShoulder(s)ChestHip(s)
NeckEye(s)Arm(s)HeartThigh(s)
UpperFaceElbow(s)AbdominalLeg(s)
TrunkForeheadWrist(s)BackKnee(s)
LowerGeneralHand(s)Shin(s)
N/AJawFinger(s)Calve(s)
NoseAnkle(s)
Foot/Feet
Toe(s)
Body Area End
Attributable Factor Start
FactEnvironmentalMaterielHumanErrorN/A
EnvironmentalN/AN/AComplacencyN/A
MaterielOver-Confident
HumanErrorUnsupervised
N/AUndisciplined
Untrained
Attributable Factor End
GFE/GFF Start
Government Furnished Equipment
Government Furnished Facility
Other
N/A

GFE/GFF End

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