EXHIBIT D _ FACTOR 3 SAFETY.pdf

MULTI-FUNCTION MASC N62473-21-R-0020

NAVFAC SW AOR SOURCE SELECTION PLAN

REV JAN 2018

SOURCE SELECTION SENSITIVE INFORMATION

DISCLOSURE LIMITATIONS AS OUTLINED IN FAR 2.101 & 3.104 APPLY

EXHIBIT D

FACTOR 3 - SAFETY

PROJECT DATA SHEET

This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. 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):

2. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate

20XX 20XX 20XX 20XX 20XX

Instructions for calculating the DART rate can be found at http://www.bls.gov/iif/osheval.htm.

3a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:

3b. Explain any negative DART Rate trends:

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

3a. Explain any extenuating circumstances resulting in any EMRs greater than 1.0, and address any corrective action(s) taken:

3b. Explain any upward EMR trends:

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

MULTI-FUNCTION MASC N62473-21-R-0020

EXHIBIT D (continuation)

FACTOR 3 - SAFETY

SAFETY NARRATIVE

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

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

6a. 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:

MULTI-FUNCTION MASC N62473-21-R-0020

EXHIBIT D (continuation)

FACTOR 3 - SAFETY

SAFETY NARRATIVE

6b. Describe the evaluation process used to select potential subcontractors:

MULTI-FUNCTION MASC N62473-21-R-0020

EXHIBIT D (continuation)

FACTOR 3 - SAFETY

SAFETY NARRATIVE

6c. 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):

MULTI-FUNCTION MASC N62473-21-R-0020

EXHIBIT D (continuation)

FACTOR 3 - SAFETY

SAFETY NARRATIVE

7. Provide the Technical Approach for Safety using this form. The Technical Approach for Safety Narrative shall not exceed two (2) single-sided pages (or one (1) double-sided page). Any additional pages will not be considered.

Technical Approach for Safety:

7a. Describe the plan the offeror will implement to evaluate the safety program and performance of potential subcontractors:

7b. Describe the plan to monitor subcontractor worksite safety:

7c. Describe any innovative methods the offeror will employ that may enhance worksite safety for this procurement:

Note: Form may be expanded.