C12_Att_10_-_Safety_Data_Sheet.docx
DOCX document 27 KB Posted
- Attached to
- Bldg 514 Temporary Heat
- Solicitation number
- N0025324Q0074
About this file
This document is a Safety Data Sheet that is required to be completed by offerors for a federal contract opportunity. It requests information on the offeror's insurance carrier, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate, and Total Recordable Case (TCR) Rate for the past 5 calendar years. The offeror is also required to provide a safety narrative describing their approach to implementing and executing a Safety Management System, the evaluation process used to select subcontractors, and the processes for overseeing subcontractor safety compliance.
The related federal contract opportunity is for installing temporary heat in Building 514 at NAVSEA NUWC Division, Keyport. The solicitation number is N0025324Q0074, the estimated value is $100,000 to $150,000, and the target award date is October 31, 2024. The opportunity is being issued under FAR Parts 13 and 36 using a Low Price Technically Acceptable evaluation approach. An organized site visit is included, and all responsible sources may submit proposals.
View the file
Other files
Show all 15
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
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
| 2019 |
| 2020 |
| 2021 |
| 2022 |
| 2023 |
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
| 2019 |
| 2020 |
| 2021 |
| 2022 |
| 2023 |
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 .