C12_Att_10_-_Safety_Data_Sheet.docx
DOCX document 27 KB Posted
- Attached to
- ADA Door Openers Federal contract opportunity
- Solicitation number
- N0025324Q0069
About this file
This document is a Safety Data Sheet to be completed by an offeror for a federal contract opportunity. It requests information on the offeror's safety record, including OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) rates and Total Recordable Case (TCR) rates for the past 5 years. The offeror is also required to provide a safety narrative describing their safety management system, subcontractor evaluation and oversight processes.
The related federal contract opportunity is for the provision and installation of new ADA/ABA low energy automatic door openers at the Naval Undersea Warfare Center Division (NUWC) Keyport in Washington. The solicitation number is N0025324Q0069, the NAICS code is 238290 Other Building Equipment Contractors, and the estimated value is $50,000 to $100,000. The contract will be a firm fixed price construction type, set aside for small businesses, and awarded utilizing a Low Price Technically Acceptable evaluation approach. The target award date is December 13, 2024.
View the file
Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| C11b_Att_02_-_WA20240109_10242024.pdf | ||
| C24_N0025324Q00690001.pdf | ||
| C12_Att_08_-_Bid_Form.docx | DOCX document | |
| C12_Att_01_-_Material_Equipment_In_Place_List.xlsx | XLSX spreadsheet | |
| C11b_Att_02_-_WA20240109_09272024.pdf | ||
| C12_Att_03_-_Safety_Requirements_for_Contractors_and_Subcontractors.pdf | ||
| C12_Att_05_-_OPSEC_Guide_for_Defense_Contractors.pdf | ||
| C12_Att_04_-_Contractors_Guide_to_Env_Compliance.pdf | ||
| C11d_Att_07_-_Past_Performance_References.docx | DOCX document | |
| C12_Att_12_Bldg1003_ADA_Drawing.pdf | ||
| C11_N0025324Q0069.pdf | ||
| C12_Att_06_-_Schedule_of_Values.xlsx | XLSX spreadsheet | |
| C12_Att_09_-_PPI_Form.docx | DOCX document | |
| C12_Att_11_-_OSHA_Calculating_Injury_and_Illness_Incident_Rate.pdf |
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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
| 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 .