Exhibit D - Safety Data Sheet.docx
DOCX document 25 KB Posted
- Solicitation number
- N6247320R0022
About this file
This document contains a safety data sheet and narrative template for a federal construction contract solicitation. The solicitation seeks a firm-fixed price contract to design and build a new wastewater treatment plant for the Marine Corps Air Ground Combat Center in Twentynine Palms, California. The project includes constructing a new primary and bypass headworks, sludge removal drying system, clarifiers, tertiary treatment system, tertiary filtration system, pump stations, chlorination disinfection system, and a treatment plant operations building. The facility must implement anti-terrorism and force protection measures in accordance with DoD standards. Offerors must submit safety data for the past three years, including experience modification rates, OSHA DART and TRC rates, and insurance information. The narrative must describe the offeror's plans for evaluating subcontractor safety, overseeing on-site safety compliance, using innovative safety practices, and facilitating mishap prevention.
The document is a template for offerors to submit the required safety information in response to the Department of the Navy solicitation for the wastewater treatment plant construction contract.
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Other files
| File | Type | Posted |
|---|---|---|
| AMENDMENT 0002 N6247320R0022 6.16.2020.pdf | ||
| AMENDMENT 0001 N6247320R0022 6.3.2020.pdf | ||
| Exhibit C Past Performance Small Business Utilization.docx | DOCX document | |
| Exhibit B Construction and Design PDS.docx | DOCX document | |
| Attachment A Past Performance Questionnaire.docx | DOCX document | |
| Exhibit A Offeror Team Composition and Management.docx | DOCX document | |
| Phase I - Offerors Team Consent Form.doc | DOC document | |
| Contract Pricing Schedule P1231.xlsx | XLSX spreadsheet | |
| RFP N6247320R0022 - P1231 Wastewater Treatment Plant MCAGCC 29 Palms CA.pdf | ||
| Exhibit E Small Participation Plan.docx | DOCX document |
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Text version
EXHIBIT “D”
SAFETY DATA SHEET
N62473-20-R-0022
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):
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. DART Rates, explain any extenuating circumstances and corrective actions taken in achieving this DART rate:
6b. Explain any negative DART Rate trends (if applicable):
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 DATA SHEET
N62473-20-R-0022
| 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. TRC Rates, explain any extenuating circumstances and corrective actions taken in achieving this TRC rates:
8b. Explain any negative TRC Rate trends (if applicable):
8c. If you do not have a TRC Rate for a given year, state so here and explain why:
EXHIBIT “D” (continuation)
SAFETY NARRATIVE
N62473-20-R-0022
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 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/or subcontractor performed work:
Note: Form may be expanded up to the page limit specified in the RFP.
EXHIBIT “D” (continuation)
SAFETY NARRATIVE
N62473-20-R-0022
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/or 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:
Exhibit “D” – Safety Data Sheet/Safety Narrative, Page 3 of 4
(Rev 07/17)
File details come from the government source that posted it. Updated .