C12_Att_10_-_Safety_Data_Sheet.docx
DOCX document 27 KB Posted
- Attached to
- Bldg 1051 Repair Cracks and Floor Coating
- Solicitation number
- N0025325Q0006
About this file
This is a Safety Data Sheet template form that contractors must complete as part of their proposal submission. The form requires offerors to provide safety information including insurance carrier details and five years of safety metrics (2019-2023) for OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate and Total Recordable Case (TCR) Rate. Joint Ventures must submit separate forms for each partner.
The form also requires a two-page Safety Narrative describing the contractor's Safety Management System implementation approach, including management involvement, employee participation, hazard prevention/control, worksite analysis, and safety training. Additionally, offerors must detail their subcontractor evaluation process and explain how they will oversee safety compliance of subcontractors throughout contract performance. This form supports a solicitation for epoxy flooring replacement work at Building 1051 at Naval Undersea Warfare Center Division Keyport.
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Other files
| File | Type | Posted |
|---|---|---|
| C24_N0025325Q00060002.pdf | ||
| C24_N0025325Q00060001.pdf | ||
| C26_WD_WA20250109_mod1_02072025.pdf | ||
| C11b_Att_02_-_WA20250109_01032025_Mod0.pdf | ||
| C11_N0025325Q0006.pdf | ||
| C12_Att_04_-_Contractors_Guide_to_Env_Compliance.pdf | ||
| C12_Att_01_-_Material_Equipment_In_Place_List.xlsx | XLSX spreadsheet | |
| C12_Att_09_-_PPI_Form.docx | DOCX document | |
| C12_Att_08_-_Bid_Form.xlsx | XLSX spreadsheet | |
| C12_Att_11_-_OSHA_Calculating_Injury_and_Illness_Incident_Rate.pdf | ||
| C12_Att_03_-_Safety_Requirements_for_Contractors_and_Subcontractors.pdf | ||
| C11d_Att_07_-_Past_Performance_References.docx | DOCX document | |
| C12_Att_06_-_Schedule_of_Values.xlsx | XLSX spreadsheet | |
| C12_Att_05_-_OPSEC_Guide_for_Defense_Contractors.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 .