JM2_N6945020R0067_Safety_Data.docx
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- Solicitation number
- N6945020R0067
About this file
This safety data sheet template requests safety information from offerors for a federal contract opportunity issued by the Department of the Navy Naval Facilities Engineering Command. Offerors are asked to provide their experience modification rates, OSHA days away from work rates, and total recordable case rates for the previous three calendar years, and explain any rates above thresholds or trends. Offerors must also describe their technical approach to safety in no more than two pages, including their safety management system to oversee compliance and performance for self-performed and subcontracted work, innovative safety monitoring methods, and methodology to execute an effective mishap prevention program. The related federal contract opportunity is for inmate management services at Naval Air Station Pensacola in Florida, Naval Hospital Pensacola, and surrounding areas, requiring coordination and administration of a Federal Bureau of Prisons inmate workforce performing various public works and facility maintenance functions at these locations.
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SAFETY DATA SHEET
This form is to be completed by the offeror. Use this form to provide safety information for the Safety factor. EMR, DART and TRC rates shall not be submitted for subcontractors.
Joint Venture (JV) or Partnership: Provide a Safety Data Sheet for each contractor who is part of the JV or partnership; however, only one safety narrative is required.
1. Offeror Name:
Name of JV partner providing the information below (if applicable):
Offeror’s Three 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.
| 2. Experience Modification Rate (EMR): |
| 2018 |
| 2017 |
| 2016 |
2a. Explain any extenuating circumstances resulting in any EMRs greater than 1.0:
2b. Explain any upward or downward EMR trends:
2c. If you do not have an EMR for a given year, state so here and explain why:
| 3. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate |
| 2018 |
| 2017 |
| 2016 |
3a. Explain any extenuating circumstances resulting in any DART Rates of 3.0 or greater:
3b. Explain any upward or downward DART Rate trends:
3c. If you do not have a DART Rate for a given year, state so here and explain why:
| 4. Total Recordable Case (TRC) Rate |
| 2018 |
| 2017 |
| 2016 |
4a. Explain any extenuating circumstances resulting in any TRC Rates of 4.5 or greater:
4b. Explain any upward or downward TRC Rate trends:
4c. If you do not have a TRC Rate for a given year, state so here and explain why:
SAFETY DATA SHEET (Continuation)
5. Technical Approach for Safety: Provide the Safety Narrative using this form. Do not exceed 2 pages. Any additional pages will not be considered.
Describe the plan for safety that will be implemented to evaluate safety performance of potential subcontractors as a part of the selection process for all levels of subcontractors:
Fully describe the safety management system that will be used to oversee the safety compliance and performance of self-performed and subcontract performed work.
Describe any innovative methods that will be employed to ensure and monitor safe work practices at self-performed and/or all subcontractor levels:
Describe the methodology to execute an effective program that facilitates sound mishap prevention techniques and processes, employee reporting of unsafe conditions, unsafe activities, and near-miss mishaps.
File details come from the government source that posted it. Updated .