5_Solder_Mask_Printer_A001_DI-MGMT-81580_Safety_Plan.pdf

CONTRACT DATA REQUIREMENTS LIST Form Approved

(1 Data Item) OMB No. 0704-0188

Public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding thus burden estimate or any other aspect of this collection o f information, including suggestions for reducing this burden, to Department of Defense, Washington Headquarters Services, Directorate for Information Operations and Reports, 1215 Jefferson Davis Highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget. Paperwork Reduction Project (0704-0188), Washington, DC 20503. Please DO NOT RETURN your form to either of these addresses. Send completed form to the Government Issuing Contracting Officer for the Contract|PR No. listed in Block E.

A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY:

TDP TM OTHER SAFTX

F. CONTRACTOR E. CONTRACT/PR NO.

1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE 17. PRICE

GROUP

CONTRACTOR'S STANDARD OPERATING

PROCEDURES

4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE 18. ESTIMATED

TOTAL PRICE

DI-MGMT-81580 PD para 5.5.2

7. DD 250 REQ 9. DIST STATEMENT

REQUIRED

10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

DD AS REQUIRED AS REQUIRED b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT

SUBMISSION

a. ADDRESSEE DRAFT FINAL

A D SEE BLK 16 AS REQUIRED Reg Repr o

16. REMARKS 1 1

Block 4 & 5: Contractor format is acceptable. Contractor shall submit a Safety and Health Plan in accordance with the elements listed in Appendix C.

Block 7: The Government will accept the Receiving Report through WAWF.

Contractor shall submit the Receiving Report upon final submission.

Block 8, 10-12: Contractor shall submit a Health and Safety Plan within 10 working days after contract award. Written Government acceptance/comments will be within 10 working days after receipt of data. Contractor final submission shall be submitted within 10 working days of receiving Government comments. Acceptance by the Government is required prior to formal distribution.

Block 9: Distribution authorized to the Department of Defense and U.S. DoD contractors only. Other requests shall be referred to the contract management team, AFSC/PZIO, 375 Perry Street, Bldg 255, Robins AFB, GA 31098.

Block 11, 13: If, during the performance of this contract, changes to the Safety and Health Plan are required, submit the revised Safety and Health Plan to AFSC/PZIO, 375 Perry Street, Bldg 255, Robins AFB, GA 31098 and the Safety Office,WR-ALC/SE. Procedures identified for blocks 8, 10-12 will apply.

Block 14: Procurement Officer(s) e-mail along with Integrated Product Team e-mail distro list will be provided as required. Electronic media shall be provided by CD/DVD media in Microsoft Office compatible format.

Notification to be sent to the following addresses:

WR-ALC/SE, 420 Richard Ray Blvd, Suite 100, Robins AFB GA 31098 WR-ALC/OBCA, 420 Richard Ray Blvd, Suite 100, Robins AFB GA 31098 AFSC/PZIO, 375 Perry Street, Bldg 255, Robins AFB, GA 31098

15. Total

G. PREPARED BY H. DATE I. ACCEPTED BY J. DATE

DD FORM 1423-1, Feb 2001 Previous editions are obsolete Page 1 of 1 Pages

A001

569 EMXS/MXDXA

SEE BLK 16

Laura Faith

X

D. SYSTEM ITEM

INKJET SOLDER MASK PRINTER

8/16/2017