HH MACC_Exhibit E_Safety Data Sheet.docx

EXHIBIT “E”

SAFETY DATA SHEET

N62473-21-R-1402

This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. DART rates and TCR shall not be submitted for subcontractors, except as noted (in Factor 4 – Safety) for Small Business Offerors utilizing first-tier Small Business subcontractor experience.

Joint Venture (JV) or Partnership: Complete Blocks 1 through 4 for each business entity who is part of the JV or partnership. Small Business Offerors utilizing first-tier Small Business subcontractor experience: Complete Blocks 1 – 4 for the Small Business Offeror and each first-tier Small Business subcontractor.

1. Offeror Name:

Name of JV member, partner, or first-tier Small Business subcontractor providing the information below (if applicable):

Offeror’s Five 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.

Instructions for calculating the DART rate can be found in the solicitation.

2a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:

2b. Explain any negative DART Rate trends and any corrective actions taken for improvement:

2c. If you do not have a DART Rate for a given year, state so here and explain why:

Instructions for calculating the TCR can be found in the solicitation.

3a. For TCR of 4.5 or greater, explain any extenuating circumstances and corrective actions taken:

3b. Explain any negative TCR trends and any corrective actions taken for improvement:

3c. If you do not have a TCR for a given year, state so here and explain why:

EXHIBIT “D” (continuation)

SAFETY DATA SHEET

N62473-21-R-4102

4. If any fatalities were experienced within the five (5) calendar years specified above, state so here and explain in detail, to include root cause and corrective actions:

Note: Form may be expanded.

EXHIBIT “D” (continuation)

SAFETY NARRATIVE

N62473-21-R-1402

Technical Approach to Safety: Provide the Safety Narrative using this form.

Do not exceed 2 pages. Any additional pages will not be considered.

5a. Describe the Offeror’s approach to implementing and executing a Safety Management System (SMS) including Management/Leadership involvement, Employee involvement, Hazard prevention, Hazard control, Worksite analysis, and Safety and health training, to include the standard(s) used to benchmark the SMS:

EXHIBIT “D” (continuation)

SAFETY NARRATIVE

N62473-21-R-1402

5b. Describe the evaluation process used to select potential subcontractors:

5c. Describe the processes of how the Offeror will oversee safety compliance of subcontractors at all levels throughout performance of the contract (to include the Offeror’s own in-house workforce):

Note: Form may be expanded.

Exhibit “D” – Safety Data Sheet/Safety Narrative, Page 1 of 1

(Rev 05/2021)