CDRL D0001 - MHE WORK ORDER.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) 0MB No. 0704-0188

The public reporting burden for this collection of information is estimated to average 110 hours per response, including the lime for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports (0701-0188), 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302. Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if ii does not display a currently valid 0MB control number. Please DO NOT RETURN your form to the above address. Send completed form to the Government Issuing Contracting Officer for the ContracVPR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER ---

I

F. CONTRACTOR

1. DATA ITEM NO. 3. SUBTITLE

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE 6. REQUIRING OFFICE

7. DD250 REQ 9. DIST STATEMENT 10. FREQUENCY

REQUIRED

12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

b. COPIES 8.APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT a. ADDRESSEE Final

SUBMISSION Draft Reg Repro

16. REMARKS

15. TOTAL

G. PREPARED BY H.DATE I. APPROVED BY J. DATE

DD FORM 1423-1, AUG 96 (EG) PREVIOUS EDITION MAY BE USED. Page __ of __ Pages Designed using Perform Pro, WHS/DIOR, Aug 96

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE

D0001

CLIN 0001

SOW N32205 (MSC N441)

DD

N/A

SEE BLOCK 16

SEE BLOCK 16ASGEN

N/AN/A

XXXX

A MHE Work Order Form shall be submitted for each asset (forklift, pallet jack, AWP) that details/ documents all parts utilized for a particular asset to support compliance with 29CFR1910.178(q).

Work Order Form shall include the following information at a minimum:

• Contract Number

• Ship Name

• MSC Barcode

• Date

• Part Number

• Manufacturer

• Description

• Quantity

• Installation Man-hours

All parts shall be OEM approved.

Forms shall be submitted in an Adobe or Microsoft compatible format with the following file naming convention:

CDRL#_MSC Barcode_Date in YYYYMMDD format example: CDRLE001_23-02785_20230821

A sample Work Order Form is attached and may be used to meet this requirement. An MS Excel version is available upon request.

MSC_MHEOHE@US.NAVY.MIL

D

D. SYSTEM/ITEM

Material Handling Equipment

2. TITLE OF DATA ITEM

MHE Itemized Work Order Sheet Form

E. CONTRACT/PR NO.

1301125149

Contract Number:

Ship Name:

MSC Barcode Number or Serial Number:

Part Number Description Manufacturer Qty Unit Price Installation ManHrs

Work Order Form