RFP_Attachment_13_CDRL_A048_Safety_and_Health_Plan.pdf

CONTRACT OAT A REQUIREMENTS LIST Form Approved (1 Data Item) OMB No. 0704·0188

The public reporting burden for this collection of information is estimated to everage 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 Directorate (0704~0188). Respondents should be aware that notwithstanding Iny other provision of law, no person shall be subject to any penalty tor failing to comply with a collection at information jf it does not dlsplav a currently valid OMS control number. Plea.e do not return your form to the above organization, Send completed form to the Government I ••uing Contracting Officar for the ContractlPR No. li8ted in Block E.

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

A TOP TM OTHER XENVR -

D. SYSTEM/ITEM )1 E. CONTRACT/PR NO. F.CONTRACTOR

C2ISR Division (Non-core IPTS/Wrkctrs) PR FX2399-13-00 117 TBD

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

A048 Environmental Health and Safety Plan (HSP) Safety and Health Plan

4. AUTHORITY IDala Acquisition Document No.1 16. CONTRACT REFERENCE 6. REQUIRING OFFICE

DI-ENVR-81375 PWS paras 1.3.4.6 and 4.16.5 78ABW/SE

7. DO 250 REQ 9. DIST STATEMENT 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION

DD

REQUIRED SEE BLK 16 SEEBLK 16 b. COPIES

8. APP CODE 11. AS OF DATE 13. DATE OF SUBSEQUENT s. ADDRESSEE Final E SUBMISSION DraftA SEE BLK 16 SEE BLK 16 Rog Repro

16. REMARKS 78 ABWfSE 1 Block 4 & 5: Contractor fonnat is acceptable. Contractor shall submit a Safety and Health 675 7th Street Plan in accordance with the elements listed in Appendix C. Bldg 707

Robins AFB GA 31098 Block 7: Wide Area Work Flow (WA WF) Acceptance: The Government Program Manager or Contracting Officer's Representative (COR) will accept the Receiving Report WR·ALC/GRCKC 1 through W A WF. The Contractor shall submit Receiving Report upon each submission. 235 Bryon Street

Suite 19A Block 8, and 10 through 12: Contractor shall submit a Health and Safety Plan within 10 Robins AFB GA 31098 working days after contract award. Written Government approvaVcommentsldisapproval will be provided within 10 working days after receipt of contractor's plan. Contractor final WR·ALCfGRCBD 1 submission shall be submitted within 10 working days of receiving Government's 235 Bryon Street comments. Approval by the Government is required prior to formal distribution. Suite 19A

Robins AFB GA 31098 Block 9: Distribution Statement E: Distribution authorized to DoD components only (Critical Technology and Direct Military Support) (21 February 2012). Other requests shall Intelink-·see Blk 16 ] be referred to WRALC/GRCBA, 235 Byron Street, Suite 19A, Robins AFB, GA 31098-1670.

Block II and 13: If, during the perfonnance of this contract, changes to the Safety and Health Plan are required, submit the revised Safety and Health Plan to WR-ALC/GRCKC and the Safety Office, 78 ABW/SE. Procedures identified for blocks 8,10-12 will apply.

Block 14: Procurement Officer(s) e-mail along with Integrated Product Team e-mail distribution list will be provided as required. Electronic media shall be provided by CDIDVD media in Microsoft Office compatible fonnat.

Block 14: Submission via Government approved electronic fonnat (Intelink), in Microsoft (MS) Office 2003, or later. NotifY Government Procurement Contracting Officer (PCO) and COR bye-mail of submission into Intelink. The PCO and COR e-mail addresses will be provided in the contract or in a separate contractual memorandum. Contractor shall request access to Intelink site at www.intelink.gov/. Once Intelink access is granted, contractor shall post data to the following URL address:

https:llwww.intelink.gov/siteslisrdcgsaflOEMlC2ISR%20Division%20Support''1020and% 20ServiceslFonnsi AllItems.aspx

All electronically delivered files shall be screened for virus and delivered virus free.

16. TOTAL ~ i.'1 0 'i 0

G. PREPARED BY H. DATE I.'::;~/ J. DATE

!J&~J~JOHNSON.DANNY.J.I061683220

30 May 12 .ero; ~ A:Iir-crz

DO FORM 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED. Page _1_ of_1_ Pages Adobe Professional 8,0 ii

17. PRICE GROUP

18. ESTIMATED

TOTAL PRICE