CI IV MACC - Exhibit E - Safety Data Sheet.docx
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- Solicitation number
- N6247319R1237
About this file
This document contains a safety data sheet exhibit and related federal contract opportunity for construction services. The safety data sheet requests information from offerors such as experience modification rates, OSHA recordable incident rates, insurance details, and explanations for any safety rate trends or circumstances. The related federal contract opportunity is a multiple award construction contract for commercial and institutional building projects at various government installations in six Western states. Services include new construction, renovation and repair projects ranging from $15-250 million. The Navy seeks three to five awardees for an initial two-year base period and one three-year option, with a combined maximum value of $2.5 billion. Proposals will be evaluated on technical approach, experience, past performance, safety, technical solution, small business participation, and price. Award is expected in April 2020.
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Text version
EXHIBIT “E”
SAFETY DATA SHEET
N62473-19-R-1237
This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. EMR, DART, and TRC rates shall not be submitted for subcontractors.
Joint Venture (JV) or Partnership: Complete Blocks 1 through 8 for each contractor who is part of the JV or partnership.
1. Offeror Name:
Name of JV partner providing the information below (if applicable):
Joint Venture (JV) or Partnership: Indicate which partner will be in charge of the overall Safety Program:
Offeror’s Three 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.
| 2. Experience Modification Rate (EMR): |
| 2017 |
| 2018 |
| 2019 |
3a. For EMRs greater than 1.0, explain any extenuating circumstances and corrective actions taken:
3b. Explain any negative EMR trends:
3c. If you do not have an EMR for a given year, state so here and explain why:
4. Insurance Carrier Information:
Insurance Carrier Name:
| Agent’s name: |
| Phone No.: |
| Email: |
| 5. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate |
| 2017 |
| 2018 |
| 2019 |
Instructions for calculating the DART rate can be found at http://www.bls.gov/iif/osheval.htm.
6a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:
6b. Explain any negative DART Rate trends:
6c. If you do not have a DART Rate for a given year, state so here and explain why:
Note: Form may be expanded.
EXHIBIT “E” (continuation)
SAFETY DATA SHEET
N62473-19-R-1237
| 7. U.S. Dept. of Labor, OSHA Total Recordable Case (TRC) Rate | |
| 2017 | |
| 2018 | |
| 2019 |
Instructions for calculating the TRC rate can be found at http://www.bls.gov/iif/osheval.htm.
8a. For TRC Rates of 4.5 or greater, explain any extenuating circumstances and corrective actions taken:
8b. Explain any negative TRC Rate trends:
8c. If you do not have a TRC Rate for a given year, state so here and explain why:
Note: Form may be expanded.
Exhibit “E” – Safety Data Sheet, Page 2 of 2
(Rev 03/20)
File details come from the government source that posted it. Updated .