N62473-14-R-0004_Exhibit_D_-_Safety_Exhibit.docx

EXHIBIT “D”

SAFETY DATA SHEET

N62473-14-R-0004

This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. EMR and DART 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) Years of Reported Safety Data:

Only complete year safety data will be considered. Indicate data rates as decimal figures, not whole numbers.

3a. Explain any extenuating circumstances resulting in any EMRs greater than 1.0:

3b. Explain any upward EMR trends:

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

4. Insurance Carrier Information:

Insurance Carrier Name:

* For each year, submit a completed copy of U.S. Dept. of Labor, OSHA Form 300A (Summary of Work-Related Injuries and Illnesses), latest version. This information is required regardless of number of employees in the company.

6a. Explain any extenuating circumstances resulting in any DART rates 3.0 or greater:

6b. Explain any upward DART rate trends:

6c. If you do not have a DART rate for a given year, state so here and explain why:

Note: Form may be expanded.

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

(Rev. 11/13)

EXHIBIT “D” (continuation)

SAFETY NARRATIVE

N62473-14-R-0004

Offeror Name:

7. Provide the Safety Narrative using this form. Do not exceed 2 pages. Any additional pages will not be considered.

Describe the plan the Offeror will implement to evaluate the safety program and performance of potential subcontractors as a part of the subcontractor selection process:

Describe the plan to monitor subcontractor safety:

Describe any innovative methods the Offeror will employ to enhance safety for this procurement:

Exhibit “D” – Safety Narrative, Page 1 of 1

(Rev. 11/13)