Exhibit C Safety Data Sheet.docx
DOCX document 18 KB Posted
- Attached to
- WEAPONS GENERATION FACILITY B EARLY START SITE Federal contract opportunity
- Solicitation number
- N69450-21-R-0041
About this file
This document contains an Exhibit C Safety Data Sheet template to be completed by offerors responding to Solicitation Number N69450-21-R-0041 issued by the Department of the Navy Naval Facilities Engineering Command. The solicitation is for early start site work at Barksdale Air Force Base, Louisiana, including clearing, grading, drainage, environmental remediation, building demolition, demolition and relocation of existing utilities, secure fencing, and roadway construction across 53 acres in preparation for a large industrial project at the Munitions Storage Area. Offerors must provide safety data for the previous three calendar years, including experience modification rates, insurance information, and OSHA days away from work, restricted duty or job transfer rates. Offerors must also describe their technical approach to evaluating subcontractor safety performance and any innovative safety monitoring methods.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| N69450-21-R-0041-0001.pdf | ||
| N69450-21-R-0041-0002.pdf | ||
| NEW Safety_Data_Sheet.docx | DOCX document | |
| SF-312 (Classified Information Nondisclosure Agreement).pdf | ||
| N6945021R0041.pdf | ||
| Exhibit A Construction Experience Project Data Sheet.docx | DOCX document | |
| Exhibit D Historical SB Utilization.docx | DOCX document | |
| Attachment A ProjNet How To Guide.pdf | ||
| Exhibit F Small Business Subcontracting Plan.doc | DOC document | |
| Exhibit B Past Performance Questionnaire.docx | DOCX document | |
| Exhibit E SB Participation Commitment Doc.docx | DOCX document |
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Text version
Exhibit C
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): |
| 2018 |
| 2017 |
| 2016 |
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 |
| 2018 |
| 2017 |
| 2016 |
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 |
| 2018 |
| 2017 |
| 2016 |
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 C (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:
File details come from the government source that posted it. Updated .