C12_Att_10-Safety_Data_Sheet.docx
DOCX document 24 KB Posted
- Solicitation number
- N0025325Q0015
About this file
The document is a Safety Data Sheet for a federal contract opportunity, designed to capture safety performance and management information from potential offerors. The form requires detailed safety data including OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) rates and Total Recordable Case (TCR) rates for the past five years (2020-2024). Offerors must provide their insurance carrier information and submit a comprehensive safety narrative detailing their Safety Management System (SMS), including management leadership, employee involvement, hazard prevention and control, worksite analysis, and safety training.
The safety narrative section specifically requests contractors to describe their processes for selecting and overseeing subcontractors' safety compliance, with a maximum limit of two pages. The form is part of a Naval Undersea Warfare Center Division (NUWC) Keyport solicitation (N0025325Q0015) for installing two emergency eyewash stations in Building 38/233, with a government estimate between $30,000 and $75,000. The contract is 100% set aside for small businesses, targeting a August 15, 2025 award date, and involves plumbing and industrial building repair work at Naval Base Kitsap in Washington state.
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Other files
| File | Type | Posted |
|---|---|---|
| C24_N0025325Q0015-00002.pdf | ||
| C24_N0025325Q0015-00001.docx | DOCX document | |
| C11_Att_02_WD_WA20250109_20250718.pdf | ||
| C12_Att_03-Safety_Requirements_for_Contractors_and_Subcontractors.pdf | ||
| C12_Att_09-PPI_Form.docx | DOCX document | |
| C11B_Att_02_WD_WA20250109_20250627.pdf | ||
| C11_N0025325Q0015.pdf | ||
| C12_Att_06-Schedule_of_Values.xlsx | XLSX spreadsheet | |
| C12_Att_05-OPSEC_Guide_for_Defense_Contractors.pdf | ||
| C12_Att_04-Kpt_EV_Guide_for_Contractors_Jan_2025.pdf | ||
| C12_Att_11-OSHA_Calculating_Injury_and_Illness_Incident_Rate.pdf | ||
| C12_Att_08-Bid_Form.xlsx | XLSX spreadsheet | |
| C11d_Att_07-Past_Performance_References.docx | DOCX document | |
| C12_Att_01-Material_Equipment_In_Place_List.xlsx | XLSX spreadsheet |
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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 .