C7_Att10_Safety_Data_Sheet.docx
DOCX document 24 KB Posted
- Solicitation number
- N0025326Q0011
About this file
This is a Safety Data Sheet template that offerors must complete to provide safety information for evaluation under a federal contract opportunity. The form requires submission of the offeror's name, insurance carrier information (name, agent contact details), and five complete consecutive calendar years of OSHA safety data (2020-2024) including Days Away from Work, Restricted Duty, or Job Transfer (DART) rates and Total Recordable Case (TRC) rates. Offerors must submit data as decimal figures and provide explanations for any missing years or negative safety trends exceeding moderate risk thresholds (DART rates of 3.0 or greater, or TRC rates of 4.5 or greater), including documentation of corrective actions taken.
The template also requires offerors to submit a Safety Narrative (limited to two pages) describing their Safety Management System implementation approach, including management and employee involvement, hazard prevention and control strategies, worksite analysis procedures, and training programs with applicable benchmarking standards. Additionally, offerors must describe their evaluation process for selecting subcontractors and detail their oversight processes for ensuring subcontractor safety compliance throughout contract performance, including in-house workforce safety management. For Joint Ventures or partnerships, each contractor partner must provide a Safety Data Sheet, though only one combined safety narrative is required. Subcontractor DART and TRC rates are not required to be submitted.
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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 .