PHAP_CDRL_A005.pdf
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- Psychological Health Advocacy Program Services
- Solicitation number
- FA664319RA003
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CDRL A005
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DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
Form Approved OMB No. 0704-0188
The 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 this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services and Communications Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. 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
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
Page of Pages
| 1_DATA_ITEM_NO: A005 |
| 2_TITLE_OF_DATA_ITEM: Environmental Health and Safety Plan (HSP) |
| 3_SUBTITLE: NA |
| 4_AUTHORITY_Data_Acquisit: DI-ENVR-81375 |
| 5_CONTRACT_REFERENCE: PWS Para 4.9.1 |
| 6_REQUIRING_OFFICE: AFRC/A1R Yellow Ribbon |
| 7_DID_250_REQ: |
| 8_APP_CODE: |
| DIST_STATEMENT: A |
| 10_FREQUENCY: 1 TIME |
| 11_AS_OF_DATE: 30 DADO |
| 12_DATE_OF_FIRST_SUBMISSI: 30 ARO |
| 13_DATE_OF_SUBSEQUENT_SUB: NONE |
| addressee1: CO |
| draft1: 1 |
| reg1: 1 |
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| 16_REMARKS: The Contractor shall establish and maintain a written safety program in accordance with the contract/order, applicable to Government regulations and the Safety Health Plan. |
DI-ENVR-81375 dated 19931216
10.1 -10.3.1 The Contractor shall follow instructions provided
10.3.2
a. Description of the program and project safety organization structure.
b. Identification of safety program members.
c. Description of responsibilities of the safety program members.
d. Telephone number for each safety program member.
10.3.3 Site Map. The plan shall include a site map to depict all details relevant to health and safety. The Contractor shall identify applicable items of a-d. If the building occupied by the Contractor already has a site map in place, the Contractor shall verify and validate the portions of the site map applicable. The Contractor shall determine space occupied and provide a derivative map of the Government's site map, using contractor's format.
10.3.4 - Only if applicable
10.3.5 - Only if applicable
10.3.6 - Only if applicable
10.3.7 - Contractor format
10.3.8 - If applicable
10.3.9 - Contractor format
10.3.10 - Contractor format
| 17_PRICE_GROUP: | |
| ESTIMATED_TOTAL_PRICE: | |
| G_PREPARED_BY: | |
| H_DATE: 06 June 19 | |
| 1_APPROVED_BY: | |
| J_DATE: 06 June 19 | |
| Page: 1 | |
| reg38t: 2 | |
| A_CONTRACT_LINE_ITEM_NO: 0001 | |
| B_EXHIBIT: NA | |
| TDP: | |
| TM: | |
| OTHER: NA | |
| DSYSTEMITEM: HQ AFRC/A1R Yellow Ribbon | |
| E_CONTRACTPR_NO: F5BFDP9155AW01 | |
| FCONTRACTOR: Goldbelt Glacier Health Services | |
| of_pages: 1 | |
| Reset: | |
| 2019-06-06T11:27:27-0400 | |
| HARRIS.DANTHONY.TEON.1286867770 |
| 2019-06-10T10:13:53-0400 | |
| HILL.MARY.Z.1068819560 |
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