C12_Att_12_-_Safety_Data_Sheet.docx
DOCX document 27 KB Posted
- Attached to
- Bldg 84 Heaters Federal contract opportunity
- Solicitation number
- N0025325Q0005
About this file
This is a Safety Data Sheet template that offerors must complete to provide safety information for the Safety evaluation factor related to a NUWC Keyport heater replacement project. The form requires contractors to provide insurance carrier information and safety performance data, specifically DART (Days Away from Work, Restricted Duty, or Job Transfer) and TCR (Total Recordable Case) rates for the past five calendar years (2019-2023).
The form also requires a two-page safety narrative describing the contractor's Safety Management System implementation, including management involvement, hazard prevention/control, worksite analysis, and safety training. Contractors must detail their subcontractor selection process and explain how they will oversee safety compliance of subcontractors throughout contract performance. For joint ventures, each partner must submit safety data, though only one safety narrative is required. The form specifically notes that DART and TRC rates are not required for subcontractors, and any rates above moderate risk (DART ≥ 3.0 or TCR ≥ 4.5) require detailed explanations of corrective actions.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| C24_N0025325Q00050001.pdf | ||
| C26_WD_WA20240109_mod5_12202024.pdf | ||
| C26_Concept_Drawing_REV01.pdf | ||
| C11_N0025325Q0005.pdf | ||
| C12_Att_07_-_Photographs_Distro_A.pdf | ||
| C12_Att_04_-_Contractors_Guide_to_Env_Compliance.pdf | ||
| C12_Att_06_-_Concept_Drwg_Distro_A.pdf | ||
| C12_Att_08_-_Schedule_of_Values.xlsx | XLSX spreadsheet | |
| C12_Att_13_-_OSHA_Calculating_Injury_and_Illness_Incident_Rate.pdf | ||
| C12_Att_03_-_Safety_Requirements_for_Contractors_and_Subcontractors.pdf | ||
| C12_Att_10_-_Bid_Form.xlsx | XLSX spreadsheet | |
| C12_Att_11_-_PPI_Form.docx | DOCX document | |
| C11d_Att_09_-_Past_Performance_References.docx | DOCX document | |
| C11b_Att_02_-_WA20240109_10252024.pdf | ||
| C12_Att_05_-_OPSEC_Guide_for_Defense_Contractors.pdf | ||
| 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
| 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 .