EXHIBIT D - Safety Data Sheet.docx
DOCX document 17 KB Posted
- Attached to
- FY20 MCON Funded Project P-1090 I MEF Consolidated Information Center, Marine Corps Base Camp Pendleton
- Solicitation number
- P-1090
About this file
This document contains a safety data sheet exhibit for a federal construction contract solicitation. The solicitation seeks a construction contractor to build a consolidated information center at the Marine Corps Base Camp Pendleton in Oceanside, California. The project scope includes constructing a multi-story information center building, headquarters administration building, parking facilities, and support structures including a central plant and area distribution node for communications infrastructure. The contract value is estimated to be between $25-100 million. Offerors must provide safety data for the previous three years, including experience modification rates, OSHA DART and total recordable case rates with explanations for any high rates or negative trends. The safety narrative must describe the offeror's safety management system and subcontractor evaluation process, as well as any innovative safety practices, mishap prevention techniques, and employee reporting programs.
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Other files
| File | Type | Posted |
|---|---|---|
| Amendment 0001_P 1090.pdf | ||
| P 1090 Questions and Answers.pdf | ||
| EXHIBIT A - Construction Experience.docx | DOCX document | |
| P1090 Solicitation N6247320R0055.pdf | ||
| EXHIBIT B - PPQ.docx | DOCX document | |
| EXHIBIT E - Small Business Participation Plan.docx | DOCX document | |
| EXHIBIT C - Past Performance Small Business Utilization.docx | DOCX document |
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Text version
EXHIBIT “D”
SAFETY DATA SHEET
N62473-20-R-0055
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. Only one safety narrative (Block 9) 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): |
| 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 “D” (continuation)
SAFETY NARRATIVE
N62473-20-R-0055
| 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:
EXHIBIT “D” (continuation)
N62473-20-R-0055
9. Technical Approach for Safety: Provide the Safety Narrative using this form. Do not exceed page limitation specified in the RFP. Any additional pages will not be considered.
Describe the plan for safety 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 the safety management system that the Offeror will use to oversee the safety compliance and performance of self-performed and subcontractor performed work:
Note: Form may be expanded up to the page limit specified in the RFP.
EXHIBIT “D” (continuation)
N62473-20-R-0055
9. Technical Approach for Safety (continuation): Provide the Safety Narrative using this form. Do not exceed page limitation specified in the RFP. Any additional pages will not be considered.
Describe any innovative methods that the Offeror will employ to ensure and monitor safe work practices at self-performed and all subcontractor levels:
Describe the methodology that the Offeror will use in order to execute an effective program that facilitates sound mishap prevention techniques and processes, employee reporting of unsafe conditions, unsafe activities, and near-miss mishaps:
Describe the Offeror’s “Good Catch” Program:
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