N4008520R0152 Section J Attachments.docx

Section J – 0200000 Management and Administration Table of Contents

Attachment J-0200000-01 Definitions and Acronyms

One who can identify existing and predictable hazards in the working environment or working conditions that are dangerous to personnel and who has authorization to take prompt corrective measures to eliminate them.

All indirect cost associated with construction equipment, such as: the Contractor’s hourly composite trade wage, adjusted to allow for workforce productivity; sub-contractor cost, costs for pre-expended bin materials, shipping and handling, union agreements, crew sizes, hand tools, universal equipment (excluding construction equipment), mobilization, demobilization, payroll burdens and fringes, overtime, job (field) overhead (including clerical support, supervision, inspection, fees, taxes, licenses, permits, and insurance), general and administrative (home office) overhead, profit, and all other associated markups shall not be included in the equipment price since the cost for these items were included in the labor hour unit price bid. Additionally, time for job preparation, safety standby personnel, and similar indirect labor elements shall not be included.

$100,000.00 + ($100,000.00 x 10%) = $110,000.00

The Government will compensate the Contractor for the required parts and materials and not the total amount shown in Schedule of Nonrecurring Work.

Biennial (B). Services performed once during each 24-month period of the contract at internals of 670 to 790 days.

Daily (D5). Services performed once each calendar day, Monday through Friday, including holidays unless otherwise noted.

Daily (D7). Services performed once each calendar day, seven days per week, including weekends and holidays.

Monthly (M). Services performed 12 times during each 12-month period of the contract at intervals of 28 to 31 calendar days.

Quarterly (Q). Services performed four times during each 12-month period of the contract at intervals of 80 to 100 calendar days.

Semiannual (SA). Services performed twice during each 12-month period of the contract at intervals of 160 to 200 calendar days.

Semimonthly (SM). Services performed 24 times during each 12-month period of the contract at intervals of 14 to 16 calendar days.

Three times weekly (3W). Services performed three times a week, such as Monday, Wednesday, and Friday.

Twice weekly (2W). Services performed twice a week, such as Monday and Thursday or Tuesday and Friday.

Weekly (W). Services performed 52 times during each 12-month period of the contract at intervals of six to eight calendar days.

· Identify applicable federal, state, and local regulations pertaining to the generation and management of hazardous waste.

· Identify training requirements and describe procedures for obtaining training and maintaining training records.

· Assign responsibilities for the generation, designation, handling, storage, treatment, disposal, and all documentation.

· Describe all hazardous waste generation and management procedures.

· Include or reference the hazardous waste minimization plan and goals.

· Include or reference contingency plans and emergency response procedures.

The plan shall be kept up to date to include changes in hazardous waste generation and management procedures, as well as changes in applicable federal, state, and local hazardous waste regulations. The plan shall include or reference minimization procedures sufficient to achieve DOD minimization goals. Tenant activities are covered by the host CO's Hazardous Waste Management Plan.

Non-RCRA regulated waste (while not meeting the definition of a Hazardous Waste) must be managed according to its applicable regulations and may not be discarded into the general trash.

Individual RPIE’s can be combined to make a CIMU to facilitate facilities management. An individual RPIE can also be a CIMU if the equipment is complex enough to require its own management planning.

Attachment J-0200000-01 Definitions and Acronyms

Attachment J-0200000-02 Wage Determinations

Included in Solicitation Section J

Attachment J-0200000-03 Directives, Instructions, and References

https://www.navfac.navy.mil/navfac_worldwide/specialty_centers/ncc.html

Attachment J-0200000-04 Invoice Form

The Non-recurring Work line items will be ordered by DOD FedMALL, Credit Card order via FISC, or by Task Order as appropriate

Common information needed for invoicing is below

Supporting Documents to be provided with monthly invoice.

1.1 Payroll Management Report: The contractor shall maintain a daily account of payroll information pertinent to specific contract services ordered. This applies to both Recurring Work Price Lump Sum and Non-Recurring Work. This data shall be submitted with the invoice and contain as a minimum the following:

a. The man-hours expended on the Recurring Price Lump Sum work -

b. The man-hours expended on the Non-Recurring work -

Note: Unsupported, incomplete invoices will be returned to the Contractor for revision and resubmittal.

1.2 The Contractor shall specifically certify each monthly report as follows:

I hereby certify on behalf of (Name of Company or Firm) that the employees listed on the attached payroll account (reference 1.1) for the month of , 20 , on Contract __________________ worked the number of hours reported.

Signature of Contractor

Attachment J-0200000-05 Forms

Attachment J-0200000-05-01

ATTACHMENT "A"

Contractor Name (Print Legibly):

Contractor Name (Signature):

Attachment J-0200000-05-02

Contractor Incident Report System (CIRS) Initial Report Follow-up Report Final Report

Contractor Contact Information

2. Incident Type (Please Check/Bold All That Apply)

Equipment

(Select Additional Below)

Industrial Incident Additional Information (Please Check/Bold All That Apply)

Confined Space Hand and Power Tools Work Platforms and Scaffolding

Demolition/Renovation Rigging Underground Construction, Shafts, and Caissons

Trenching/Entrapment Cranes and Hoisting Equipment Concrete, Masonry, Steel Erection and Residential Construction

Traffic Control Floating Plant and Marine Activities Tree Maintenance and Removal

Welding and Cutting Pressurized Equipment and System Airfield and Aircraft Operations

Control of Hazardous Energy Fall Protection

3. General Information Incident Information

Describe the accident in detail in your words: (Use the back of page if you need additional space)

Exact Location of Accident:

Were Hazardous Material(s) Involved Yes No If Yes, Explain What Hazardous Materials Were Involved and Why:

Who Provided Clean-up? Onsite Base Public

Activity of the injured person at the time of incident:

Personal Protective Equipment: (Check/Bold Response)

Available and used Available and not used Not Required

Not related to Mishap Wrong PPE for job

List PPE Used:

4. Fully Explain What Allowed or Caused the Incident: Incident Information

Direct Cause:

Indirect Cause:

Additional Action Taken: (Please Include a Begin Date and Est. End Date in Description)

Additional Action Taken: (Please Include a Begin Date and Est. End Date in Description) (Use the back of page if you need additional space)

5. Contributing Factors:

Unit of Measure (Check/Bold): Feet Yards Meters Miles Nautical Miles

Visibility Restricted By: (Check/Bold all that apply)

Fog Smoke Rain Sleet Snow

Mist Dust Sandstorm Unknown Object Other:

Lighting Conditions at Site of Mishap:

(Please Check)

(Please Check)

If Yes CO Alarm Manufacturer:

5. Contributing Factors: Continued Incident Information

Other Contributing Factors:

6. Attached Documents

Attached Documents/Files Name/Description:

Date Added:

Uploaded By:

1. Injured Data (if applicable) Person #

2. General Information

Drug or Alcohol Involved: (Check/Bold all that apply)

None Unknown Alcohol Drugs Alcohol and Drugs

Who Provided First Aid? Onsite Base Public

Was Ergonomics a Factor: (Check/Bold) Yes No

Type of Ergonomic Injury: (Check/Bold All That Apply)

Lifting Positioning Bending Equipment Placement Office

Equipment Placement Industrial Repetitive Motion Impact Strain

3. Injury Illness/Fatality Information

Part of Body Affected:

Nature of Injury or Illness:

Event or Exposure:

Source of Injury or Illness:

General Location Description:

Injury Activity Code:

4. License (if applicable) Person #

Are Appropriate License and Certification/Medical Current: (Check/Bold) Yes No

Describe or Explain:

Attach Image of License or Certification Name/Description:

5. Training

Was all the contract-required training provided to the employee: (Check/Bold) Yes No

Explain:

6. Attached Documents

Attached Documents Name/Description:

1. Involved Person Data (if applicable) Property Damage

2. Attached Documents

Attached Documents Name/Description:

3. Property Damaged

Property Type

Property ID #

Detailed Description

Property Owned By

Estimated Cost USD Lost Use Days

4. License (if applicable) Property Damage

Are Appropriate License and Certification/Medical Current: (Check/Bold) Yes No

Describe or Explain:

Attach Image of License or Certification Name/Description:

5. Training

Was all the contract-required training provided to the employee? (Check/Bold) Yes No

Explain:

CONTRACTOR INCIDENT REPORT SYSTEM (CIRS) INSTRUCTIONS Complete Only Sections Appropriate to Incident (Rev. 03/11).

NOTE: THE ATTACHED CIRS FORM IS TO BE USED BY CONTRACTORS TO RECORD THE RESULTS OF THEIR ACCIDENT/INCIDENTS INVESTIGATIONS AND SHALL BE PROVIDED TO THE CONTRACTING OFFICER WITHIN THE REQUIRED TIMEFRAMES.

GENERAL. Complete a separate report for each person who was injured in the accident pages 5-6. A report needs to be completed for all OSHA recordable accidents and property damage cases. Please type or print legibly. Appropriate items shall be Checked/Bolded, non-applicable sections shall be marked “N/A”. If additional space is needed, provide the information on a separate sheet of paper and attach to the completed form.

Mark the report: (Check/Bold) Initial: If this form is being used as initial notification of a Fatality or High Visibility Mishap. The initial form is due within 4 hours of a serious accident. A form marked ‘Follow-up’ or ‘Final’ is required within 5 days.

Follow-Up: If you are providing additional information on a report previously submitted.

Final: If you are providing a completed report and expect no changes.

Incident Information Section 1 Contract Information – Incident Information Prime Contractor: Name as it appears on contract documents.

Cage Code: If known.

Contract Number: Number as it appears on the contract documents.

Installation: Name of installation where incident occurred.

Task Order #: Insert number if applicable.

Contracting Activity/ROICC Office: Enter the name and address of the Contracting Office administering the contract under which the mishap took place (e.g. ROICC MCBH, ROICC NORFOLK, PWC GUAM, etc.).

Contractor Contact Information: (Contractor point of contact information for the individual responsible for completing the form) Self Explanatory

Section 2 Incident Type: Check/Bold most applicable category, if you select Industrial you must Check/Bold at least one additional category from the Industrial Incident Additional Information Section.

Section 3 General Information Incident Information Date of Accident: Enter the month, day, and year of accident.

Time of Accident: Enter the local time of accident in military time. Example: 14:30 hrs (not 2:30 p.m.).

Describe the Accident in Detail in your words: Fully describe the accident in the space provided. If property damage involved, give estimated dollar amount of damage and repair costs involved. If additional space is needed continue on a separate sheet and attach to this report. Give the sequence of events that describe what happened leading up to and including the accident. Fully identify personnel and equipment involved and their role(s) in the accident. Ensure that relationships between personnel and equipment are clearly specified. Ensure questions below regarding direct cause(s), indirect cause(s), and actions taken are answered. NOTE! Review questions in Section 4 (Fully Explain What Allowed or Caused the Incident - Incident Information) below before completing.

Exact Location of Accident: Enter facts needed to locate the accident scene (e.g. installation/project name, building/room number, street, direction and distance from closest landmark, etc.).

Were Hazardous Material(s) Involved Yes No

If Yes, Explain What Hazardous Materials Were Involved and Why: Check or Bold appropriate block and list name(s) and quantities of hazardous materials spilled/released during the mishap. List why the hazardous chemicals were being used.

Activity at the time of incident: What type of work/task was being performed by the injured when the injury took place or property damage occurred.

Personal Protective Equipment– Check/Bold appropriate items and list PPE which was being used by the injured person at the time of the accident (e.g. protective clothing, shoes, glasses, goggles, respirator, safety belt, harness, etc.)

Section 4 Fully Explain What Allowed or Caused the Incident - Incident Information Direct Cause(s): The direct cause is that single factor which most directly lead to the accident. See examples below.

Indirect Cause(s): Indirect cause are those factors, which contributed to, but did not directly initiate the occurrence of the accident.

Examples for Direct and Indirect Cause:

1. Employee was dismantling scaffold and fell 12 feet from unguarded opening.

Direct cause: Failure to provide fall protection at elevation Indirect causes: Failure to enforce safety requirements: improper training/motivation of employee (possibility that employee was not knowledgeable of fall protection requirements or was lax in his attitude toward safety); failure to ensure provision of positive fall protection whenever elevated; failure to address fall protection during scaffold dismantling in phase hazard analysis.

2. Private citizen had stopped his vehicle at intersection for red light when vehicle was struck in rear by contractor vehicle. (note contractor vehicles was in proper safe working condition.)

Direct cause: Failure of contractor driver to maintain control of and stop contractor vehicle within safe distance.

Indirect cause: Failure of employee to pay attention to driving (defensive driving).

Additional Action Taken: Fully describe all the actions taken, anticipated, and recommended to eliminate the cause(s) and prevent reoccurrence of similar accidents/illnesses. Continue in the additional box and or on additional sheets of paper if necessary to fully explain and attach to the completed report form.

Please Include a Begin Date and Estimated Completion Date in Description

(1) Begin: Enter the date when the corrective action(s) identified above will begin.

(2) Est. End Date - Enter the date when the corrective action(s) identified above will be completed.

Section 5 Contributing Factors Incident Information: Check/Bold appropriate items fill in information where required Other Contributing Factors: Describe in detail any additional contributing factors not listed in previous information provided.

Section 6 Attached Documents: Provide the appropriate information for each document/file attached or uploaded.

Injured Data Person # Complete Pages 5 and 6 for each injured person at the upper right hand corner of page 5 and 6 differentiate between each person by using a numerical value (e.g. Person #1, Person #, Person #3, etc.)

Section 1 Injured Data: Fill in all applicable information, Check/bold appropriate responses.

Section 2 General Information:

Check/bold appropriate responses

Section 3 Injury/Illness Fatality Information: Check/bold appropriate responses Part of Body Affected: Enter the most appropriate primary and when applicable, secondary, etc. body part(s) affected (e.g. arm: wrist: abdomen: single eye; jaw: both elbows: second finger: great toe: collar bone: kidney, etc.)

Attachment J-0200000-05-03

CRANE AND RIGGING GEAR ACCIDENT REPORT

Accident Category: |_| Crane Accident |_| Rigging Gear Accident

From:

UIC:

Bldg. 491 NNSY Portsmouth, VA 23709 Fax: 757-967-3808

Activity:

Report No:

Crane No:

Category:

Accident Date:

Time: hrs:

Crane Manufacturer:

Location:

Weather:

Crane Capacity:

Hook Capacity:

Weight of Load on hook:

Fatality or Permanent Disability? |_| Yes |_| No

Material/Property Cost Estimate:

|_| Load Collision |_| Two Blocked |_| Dropped Load |_| Damaged Crane

|_| Improper Rigging |_| Switch Alignment |_| inadequate Communication

Is this accident indicative of a recurring problem? |_| Yes |_| No

ATTACH COMPLETE AND CONCISE SITUATION DESCRIPTION AND CORRECTIVE/PREVENTIVE ACTIONS TAKEN AS ENCLOSURE (1). Include probable cause and contributing factors. Assess damages and define responsibility. For equipment malfunction or failure, include specific description of the component and the resulting effect or problem caused by the malfunction or failure. List immediate and long term corrective/preventive actions assigned and respective codes.

Preparer:

Phone:

E-mail:

Code:

Date:

Concurrences: (Include Code, Signature and Date)

Code:

Date:

Code:

Date:

Certifying Official (Crane Accident Only):

Code:

Date:

CRANE AND RIGGING GEAR ACCIDENT REPORT INSTRUCTIONS

This form is designed for fax transmission without a cover page or by e-mail and, with enclosures and signatures, shall be the official document. Electronic submission will be accepted without signatures but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in. The e-mail address is m_nfsh_ncc_accident@navy.mil. The fax number is (757) 967-3808.

1. Accident Category: Indicate either crane accident or rigging gear accident.

2. From: The naval activity that is responsible for reporting the accident and UIC number.

3. Activity: The naval activity where the accident took place.

4. Report No.: The activity assigned accident number (e.g., 95-001).

5. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

6. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

7. Accident Date: The date the accident occurred.

8. Time: The time (24 hour clock) the accident occurred (e.g., 1300).

9. Category of Service: Check the applicable service (SPS as defined by NAVSEA 0989-030-7000).

10. Crane Type: The type of crane involved in the accident (e.g., mobile, bridge), if applicable.

11. Crane Manufacturer: The manufacturer of the crane (e.g., Dravo, Grove, P&H), if applicable.

12. SPS: Was the crane or rigging gear being used in an SPS lift?

13. Complex lift: Was the crane or rigging gear being used in a complex lift?

14. Location: The detailed location where the accident took place (e.g., building 213, dry dock 5).

15. Weather: The weather conditions at time of accident (e.g., wind, rain, cold).

16. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

17. Hook Capacity: The capacity of the hook involved in the accident at the max radius of the operation, if applicable.

18. Weight of Load on Hook: If applicable, the weight of the load on the hook.

19. Fatality or Permanent Disability?: Check yes or no.

20. Material/Property Cost Estimate: Estimate total cost of damage resulting from the accident.

21. Reported to NAVSAFECEN?: Self-explanatory.

22. Accident Type: Check all that apply.

23. Cause of Accident: Check all that apply.

24. Chargeable to: Check all that apply.

25. Crane Function: Check all functions in operation at time of accident. Check N/A if a rigging gear accident.

26. Is this a recurring problem?: Check yes or no. Identify any other similar accidents.

27. Situation Description/Corrective Actions: Self-explanatory.

28. Preparer: Self-explanatory.

29. Concurrences: Self-explanatory.

30. Certifying Official (Crane Accidents Only): Self-explanatory.

31. Brief Description: No more than one paragraph summarizing the resultant incident.

32. Background and Detailed Description: Provide the relevant background in a descriptive timeline of preconditions leading up to the event, as well as a detailed description of the event.

33. Corrective Actions: List all short term and long term corrective actions that are taken to prevent recurrence of the incident. Short Term Corrective Actions are those actions taken that will allow return to work in short time frame. Long Term actions are more ‘programmatic’ in nature and typically include: process revision, changes in training, ‘mistake proofing’, etc.

Attachment J-0200000-05-04

CRANE AND RIGGING GEAR NEAR MISS REPORT

Near Miss Category:

Crane Near Miss

Rigging Gear Near Miss

From:

UIC:

To: Navy Crane Center Bldg 491 NNSY Portsmouth, VA 23709 Fax (757) 967-3808 nfsh_ncc_accident@navy.mil

Category of Service:

SPS

Is this near miss indicative of a recurring problem?

Yes

No

If yes, list report numbers:

In the space below, include a brief description of the event and corrective actions taken to prevent recurrence:

Preparer:

Phone and email

Attachment J-0200000-05-04

CRANE AND RIGGING GEAR NEAR MISS INSTRUCTIONS

This form is designed for fax transmission without a cover page or by e-mail and, with enclosures and signatures, shall be the official document. Electronic submission will be accepted without signatures but the names of the preparer, concurring personnel, and certifying official (for crane accidents only) shall be filled in. The e-mail address is nfsh_ncc_accident@navy.mil. The fax number is (757) 967-3808.

1. Near Miss Category: Indicate either crane or rigging gear near miss.

2. From: The naval activity that is responsible for reporting the near miss and UIC number.

3. Activity: The naval activity where the near miss took place.

4. Report No.: The activity assigned near miss number (e.g., 95-001).

5. Crane No.: The activity assigned crane number (e.g., PC-5), if applicable.

6. Category: Identify category of crane (i.e., 1, 2, 3, or 4), if applicable.

7. Near Miss Date: The date the near miss occurred.

8. Time: The time (24 hour clock) the near miss occurred (e.g., 1300).

9. Category of Service: Check the applicable service (SPS as defined by NAVSEA 0989-030-7000).

10. Crane Type: The type of crane involved in the near miss (e.g., mobile, bridge), if applicable.

11. Crane Manufacturer: The manufacturer of the crane (e.g., Dravo, Grove, P&H), if applicable.

12. Location: The detailed location where the near miss took place (e.g., building 213, dry dock 5).

13. Weather: The weather conditions at time of the near miss (e.g., wind, rain, cold).

14. Crane Capacity: The certified capacity of the crane (e.g., 120,000 pounds), if applicable.

15. Hook Capacity: The capacity of the hook involved in the near miss at the maximum radius of the operation, if applicable.

16. Weight of Load on Hook: If applicable, the weight of the load on the hook.

17. Is this a recurring problem?: Check yes or no. Identify any other similar near misses or accidents.

18. Situation Description/Corrective Actions: Self-explanatory.

19. Preparer: Self-explanatory.

Attachment J-0200000-05-05 Emergency Planning and Community Right-To-Know Act (EPCRA) Report

Attachment J-0200000-05-06 Contractor Hazardous Material Inventory Log

Contractor Hazardous Material Inventory Log

(EPRCA)

PRIME COMPANY NAME:…