A-CDRLS.pdf

PDF 189 KB Posted Feb 8, 2017

Attached to: PdM Support Services Federal contract opportunity
Solicitation number: M67854-17-R-5005
Issued by: United States Marine Corps

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Attachment 2 - A CDRLs

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File	Type	Posted
M67854-17-R-5005-02.pdf	PDF	Mar 2, 2017
D-CDRLS.pdf	PDF	Mar 1, 2017
B-CDRLS.pdf	PDF	Mar 1, 2017
M67854-17-R-5005-01.pdf	PDF	Mar 1, 2017
PAST_PERFORMANCE_QUESTIONNAIRE.docx	DOCX document	Feb 8, 2017
M67854-17-R-5005.pdf	PDF	Feb 8, 2017
D-CDRLS.pdf	PDF	Feb 8, 2017
B_&_E-CDRLS.pdf	PDF	Feb 8, 2017
QASP.pdf	PDF	Feb 8, 2017

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CONTRACT DATA REQUIREMENTS LIST

(1 Data Item)

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 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 _X __

D. SYSTEM/ITEM

System Safety Support

E. CONTRACT/PR NO.

F. CONTRACTOR

1. DATA ITEM NO.

A001

2. TITLE OF DATA ITEM

MILESTONE DECISION SUPPORT

3. SUBTITL

MILESTONE DECISION SUPPORT

4. AUTHORITY (Data Acquisition Document No.)

DI-ADMN-81373

5. CONTRACT REFERENCE

PWS PARA – 3.5.2, 3.5.22, 3.5.23, 3.5.24

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Block 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DOD Contractors only. Administrative or Operational Use, 2 February 2017. Other requests shall be referred to Commander, Marine Corps Systems Command (PM SMS), 2200 Lester Street, Quantico, Va. 22134-6050

Block 10, 11, 12, 13: Presentation material required based upon events and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). When directed, the Contractor shall also support those events described in the IMS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010 applications (or earlier) or Adobe PDF as an email. For distribution “D”, all e-mails must be encrypted.

TL 1 0 1

COR 1 0 1

15. TOTAL --------- 2 0 2

G. PREPARED BY

BRAD COBB

H. DATE

23 Dec 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 Dec 2016

DD Form 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED

C. CATEGORY:

TDP _ _ TM _ _ OTHER _X __

D. SYSTEM/ITEM

SAI

A002

SYSTEM AND SUBSYSTEM HAZARD ANALYSIS REPORT

(SSHAR)

3. SUBTITLE

SYSTEM AND SUBSYSTEM HAZARD ANALYSIS

REPORT (SSHAR)

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-80101B

5. CONTRACT REFERENCE

PWS PARA 3.5.3 and 3.5.4

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION BLK 16 Draft

Final

Reg Repro

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: One (1) System and (1) Subsystem Hazard Analysis Report required per program supported, and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit reports within 30 business days of task receipt.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

TL 1 1 0

15. TOTAL --------- 1 1 0

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

C. CATEGORY:

TDP _ _ TM _ _ OTHER _ X __

D. SYSTEM/ITEM

A003

SAFETY ASSESSEMENT REPORT

3. SUBTITLE

SAFETY ASSESSEMENT REPORT

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-80102B

5. CONTRACT REFERENCE

PWS PARA 3.5.5

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 11, 12, 13: One (1) Safety Assessment Report required per program and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH).

When directed, the Contractor shall submit first review within 30 business days of receipt of task. Subsequent reports submitted as needed per portfolio IMS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010 applications (or earlier) or Adobe PDF as an email. For distribution “D”, all e-mails must be encrypted.

COR 1

15. TOTAL --------- 1 2 0

BRAD COBB

H. DATE

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

C. CATEGORY:

TDP _ _ TM _ _ OTHER _ X

D. SYSTEM/ITEM

A004

TECHNICAL REPORT’ STUDY/ SERVICES

3. SUBTITLE

MISHAP INVESTIGATION REPORTS

4. AUTHORITY (Data Acquisition Document No.)

OPNAVINST 5102.1_

5. CONTRACT REFERENCE

PWS PARA 3.5.6

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: Mishap Investigation Reports will be completed as required and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH).

When directed, the Contractor shall submit first review within 30 business days of receipt of task. Subsequent reports submitted as needed per portfolio IMS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010 be encrypted..

TL 1 0 1

15. TOTAL --------- 1 1 1

JEFF MILLER

H. DATE

23 NOV 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 NOV 2016

C. CATEGORY:

TDP _ _ TM _ _ OTHER _ X

D. SYSTEM/ITEM

A005

PROGRAMMATIC ENVIRONMENTAL, SAFETY AND

HEALTH EVALUATION (PESHE)

3. SUBTITLE

PROGRAMMATIC ENVIRONMENTAL, SAFETY AND

HEALTH EVALUATION (PESHE)

4. AUTHORITY (Data Acquisition Document No.)

See Block 16 (Command Template)

5. CONTRACT REFERENCE

PWS PARA 3.5.7

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Prepare the Programmatic Environmental, Safety, and Health Evaluation (PESHE) in accordance with the Guide to Development of the Programmatic Environmental, Safety, and Health Evaluation (PESHE), May 2004.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Block 10, 12, 13: One (1) PESHE required per program supported in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). When directed, the Contractor shall submit PESHE within 30 business days of receipt of task.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

15. TOTAL --------- 1 1 1

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

C. CATEGORY:

TDP _ _ TM _ _ OTHER _ X

D. SYSTEM/ITEM

A006

HAZARDOUS MATERIALS MANAGEMENT PROGRAM

(HMMP) PLAN – USING NAS 411

3. SUBTITLE

HAZARDOUS MATERIALS MANAGEMENT

PROGRAM (HMMP) PLAN – USING NAS 411

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-81398C

5. CONTRACT REFERENCE

PWS PARA 3.5.8

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: One (1) HMMP Plan required per program supported and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH).

Block 14: Electronic media: submissions shall be provided in MS Office 2010 applications (or earlier) or Adobe PDF as an email. For distribution “D”, all e-mails must be encrypted.

PM 1 1

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

C. CATEGORY:

TDP _ _ TM _ _ OTHER _ X

D. SYSTEM/ITEM

A007

HAZARDOUS MATERIALS MANAGEMENT PROGRAM

(HMMP) REPORT – USING NAS 411

3. SUBTITLE

HAZARDOUS MATERIALS MANAGEMENT

PROGRAM (HMMP) REPORT– USING NAS 411

4. AUTHORITY (Data Acquisition Document No.)

DI-MISC-81398C

5. CONTRACT REFERENCE

PWS PARA 3.5.8

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

SUBMISSION BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: ONE HMMP report required per program supported, and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH).

Block 14: Electronic media: submissions shall be provided in MS Office 2010

PM 1 1

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

C. CATEGORY:

TDP _ _ TM _ _ OTHER __X__

D. SYSTEM/ITEM

A008

HAZARD TRACKING DATABASE

3. SUBTITLE

HAZARD TRACKING DATABASE

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA 3.5.9

6. REQUIRING OFFICE

Program Office

7. DD 250 REQ

9. DIST

STATEMENT

10. FREQUENCY

12. DATE OF FIRST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

BLK 16

Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with MCSC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 30 business days.

Contractor shall resubmit final document within 30 business days.

Blocks 11, 12, 13: One (1) Hazard Tracking Database required and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). The Contractor shall submit draft within 30 business days of receipt of task.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

Page 1 of 1 page

17. PRICE

GROUP

18. ESTIMATED

TOTAL PRICE

D. SYSTEM/ITEM

A009

SYSTEM SAFETY PROGRAM PLAN

3. SUBTITLE

SYSTEM SAFETY PROGRAM PLAN

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-81626

5. CONTRACT REFERENCE

PWS PARA 3.5.10

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks: 10, 12, 13: One (1) System Safety Program Plan required per program and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH).

Subsequent Plans and updated may be required. Expectation is not more than 5 new plans per year and not more than 30 updates per year across PMSMS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

TL 1 2 1

15. TOTAL --------- 1 3 1

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

DD Form 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 36 of Pages

D. SYSTEM/ITEM

A00A

OPERATING, SUPPORT, HEALTH, AND SAFETY HAZARD

ANALYSIS REPORT (OSH&S)

3. SUBTITLE

HEALTH HAZARD ANALYSIS REPORT

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-81841

5. CONTRACT REFERENCE

PWS PARA 3.5.11

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

ASREQ Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Block 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DOD Contractors only. Administrative or Operational Use, 2 February

Blocks 10, 12, 13: One Operating, Support, Health and Safety Hazard Analysis Report required per program supported and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contract shall submit to within 30 business days of task receipt.

Block 14: Electronic media: submissions shall be provided in MS Office 2010 applications (or earlier) or Adobe PDF as an email. For distribution “D”, all e-mails must

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

D. SYSTEM/ITEM

A00B

PRELIMINARY HAZARD LIST/PRELIMINARY HAZARD

ANALYSIS

3. SUBTITLE

PRELIMINARY HAZARD LIST/HAZARD ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA 3.5.12

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

ASREQ Draft Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

BLKS 10, 12, 13: One (1) Preliminary Hazard List and Preliminary Hazard Analysis required per program supported and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit within 30 business days of task receipt. Subsequent reports shall be as directed by the Government and due 30 business days after tasking and IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

DD Form 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 36 of Pages

D. SYSTEM/ITEM

A00C

SYSTEM REQUIREMENTS HAZARD ANALYSIS

3. SUBTITLE

SYSTEM REQUIREMENTS HAZARD ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA 3.5.13

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

BLKS 10, 12, 13: One (1) System Requirement Hazard Analysis required per program supported, and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit within 30 business days of task receipt.

Subsequent reports shall be as directed by the Government and due within 30 business days from receipt of tasking IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

DD Form 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 36 of Pages

D. SYSTEM/ITEM

A00D

SYSTEM AND SUBSTEM HAZARD ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA 3.5.4

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: One (1) System and one (1) Subsystem Hazard Analysis required per program supported, and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit within 30 business days of task receipt. Subsequent reports shall be as directed by the Government and due within 30 business days from receipt of tasking IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

DD Form 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 36 of Pages

D. SYSTEM/ITEM

A00E

SYSTEM OF SYSTEMS HAZARD ANALYSIS

3. SUBTITLE

SYSTEM OF SYSTEMS HAZARD ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA 3.5.14

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: One (1) System of Systems Hazard Analysis required per program supported, and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit within 30 business days of task receipt.

Subsequent reports shall be as directed by the Government and due within 30 business days from receipt of tasking IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

D. SYSTEM/ITEM

A00F

TEST AND EVALUATION ANALYSIS

3. SUBTITLE

TEST AND EVALUATION ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA – 3.5.15 and 3.5.23

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: One (1) Test and Evaluation Analysis required per program supported, and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit within 30 business days of task receipt. Subsequent reports shall be as directed by the Government and due within 30 business days from receipt of tasking IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010 applications (or earlier) or Adobe PDF as an email. For distribution “D”, all e-mails must

PM 1 1 0

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

D. SYSTEM/ITEM

A00G

HARDWARE AND SOFTWARE CHANGE REQUEST

ANALYSIS

3. SUBTITLE

HARDWARE AND SOFTWARE CHANGE REQUEST

ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA 3.5.16

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Block 9: DISTRIBUTION STATEMENT D. Distribution authorized to the Department of Defense and U.S. DOD Contractors only. Administrative or Operational Use, 2 February

Blocks 10, 12, 13: One (1) Hardware and Software Change Request Analysis per program supported and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit within 30 business days of task receipt.

Subsequent reports shall be as directed by the Government and due within 30 business days from receipt of tasking IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

D. SYSTEM/ITEM

A00H

HUMAN FACTORS ANALYSIS

3. SUBTITLE

HUMAN FACTORS ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-1472

5. CONTRACT REFERENCE

PWS PARA 3.5.17

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: One (1) Human Factor Analysis required per program supported and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH).

Contractor shall submit within 30 business days of task receipt. Subsequent analysis shall be as directed by the Government and due within 30 business days from receipt of tasking

IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

D. SYSTEM/ITEM

A00J

FUNCTIONAL HAZARD ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

MIL-STD-882E

5. CONTRACT REFERENCE

PWS PARA 3.5.18

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

BLK 16 Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format, compatible with SMC computer systems acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Blocks 10, 12, 13: One (1) Functional Hazard Analysis required per program supported, and in coordination with the Principal for Environment, Safety and Occupational Health (PESOH). Contractor shall submit within 30 business days of task receipt. Subsequent reports shall be as directed by the Government and due within 30 business days from receipt of tasking IAW PWS.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

23 DEC 2016

DD Form 1423-1, FEB 2001 PREVIOUS EDITION MAY BE USED Page 36 of Pages

D. SYSTEM/ITEM

A00K

HEALTH HAZARD ANALYSIS

3. SUBTITLE

HEALTH HAZARD ANALYSIS

4. AUTHORITY (Data Acquisition Document No.)

DI-SAFT-81841

5. CONTRACT REFERENCE

PWS PARA 3.5.19

6. REQUIRING OFFICE

PM SMS

7. DD 250 REQ

BLK 16

12. DATE OF 1ST SUBMISSION

BLK 16

14. DISTRIBUTION

a. ADDRESSEE

b. COPIES

8. APP CODE

11. AS OF DATE

N/A

13. DATE OF SUBSEQUENT

ASREQ Draft

Final

Reg Repro

16. REMARKS

Block 4: Contractor format acceptable.

Block 8: Government to review and provide comments, if necessary, in 10 business days.

Contractor shall resubmit final document within 5 business days.

Block 14: Electronic media: submissions shall be provided in MS Office 2010

BRAD COBB

H. DATE

23 DEC 2016

I. APPROVED BY

CRISTINA MIGUEL MOORE

J. DATE

File details come from the government source that posted it. Updated Nov 14, 2017.