Exhibit B.docx
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- Solicitation number
- N69450-20-R-0097_AMENDMENT_0001
About this file
This document contains a safety data sheet template to be completed by offerors responding to Solicitation Number N69450-20-R-0097 issued by the Department of the Navy Naval Facilities Engineering Command. The safety data sheet requests offerors to provide their experience modification rates, OSHA DART and total recordable case rates for the previous three years, as well as explanations for any rates above thresholds and trend analyses. Offerors must also describe their plans to evaluate and monitor safety performance of potential subcontractors. The solicitation seeks proposals for an indefinite-delivery indefinite-quantity multiple award construction contract for facilities projects within the Naval Facilities Engineering Command Southeast area of operations.
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| File | Type | Posted |
|---|---|---|
| N6945020R0097-0001.pdf |
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Exhibit B
SAFETY DATA SHEET
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: 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):
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): |
| 2019 |
| 2018 |
| 2017 |
2a. Explain any extenuating circumstances resulting in any EMRs greater than 1.0:
2b. Explain any upward or downward EMR trends:
2c. If you do not have an EMR for a given year, state so here and explain why:
3. Insurance Carrier Information:
Insurance Carrier Name:
| Agent’s name: |
| Phone No.: |
| Email: |
| 4. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate |
| 2019 |
| 2018 |
| 2017 |
4a. Explain any extenuating circumstances resulting in any DART Rates of 3.0 or greater:
4b. Explain any upward or downward DART Rate trends:
4c. If you do not have a DART Rate for a given year, state so here and explain why:
| 5. Total Recordable Case (TRC) Rate |
| 2019 |
| 2018 |
| 2017 |
5a. Explain any extenuating circumstances resulting in any TRC Rates of 4.5 or greater:
5b. Explain any upward or downward TRC Rate trends:
5c. If you do not have a DART Rate for a given year, state so here and explain why:
Exhibit B (Continuation)
SAFETY NARRATIVE
6. Technical Approach for Safety: Provide the Safety Narrative using this form. Do not exceed 2 pages. Any additional pages will not be considered.
Describe the plan that the Offeror will implement to evaluate safety performance of potential subcontractors, as a part of the selection process for all levels of subcontractors:
Describe any innovative methods that the Offeror will employ to ensure and monitor safe work practices at all subcontractor levels:
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