CDRL_A012_DID_DI-SAFT-81563_Accident-Incident_Report.pdf

DATA ITEM DESCRIPTION

Title: Accidertflncident Report

Number DI-SAFT-8 1563 Approved Date: 2 Jun 98 AMSC Numbec A7315 Limitation:

DT3C Applicable: GIDEP Application:

Office of Primary Respomibility A/AR Applicable Fornw Use/relationship: This reportprovides tAeprocuring agency with immediate notification and information concerning any mrjor acciderrthncident (including fire) resulting in any one or more of the following: causing one or more fatalities, or two or snore disabling injuries; damaging government property exceeding $10,000; atTecting program planning or production schedules;

degrading the safety of the equipment under contract, such that persomel injury or property darnage may be involved, identi@ng a potential hazard requiring corrective action.

a. This Data Item Description contains the format and content preparation instructions for the data product generated by the specific and discrete task requirement as delineated in the contract.

b. This Data Item Description replaces DI-H-I 329A.

Requirements:

1. Format. Contractor format is acceptable

2. Content. Report without delay any serious accident or incident (i.e. explosioq fire, flood pressure rupture, major rndfunction) which will adversely affect capabtity to meet contractual obligations. The report shall be made by the fkstest means, giving the following information.

c.

d.

e.

f.

i.

1.

Name, organization, telephone number, and location of the contractor and general manager Name and title of the person(s) reporting Date and time of accidenthcident Location of accidentiiciden~ i.e., building number, fkcility name Brief summary of accidentkscidcnt giving pertinent details”iircludihgtype ‘md qtiti~”of -materiel Cause of accidentliicident Camalties (fatalities, disabling irjuries, exposed to CBR agents) Estimated property damage, if applicable Nature of darnage; effect on production, operations, training or other activity Action taken by contractor Other damage or injuries sustained (public or private) Other pertinent information

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DI-SAFT-81563

3. Malfunction. If a malfunction of equipment is involved, the following additional information shall be finmished:

a. Equipment nomenclature

b. @@ity illvokd

c. Production lot number(s)

d. Brief teehnieal description of malfunction

I 4. End of DI-SAFT-8 1563

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