Attachment L-3 Safety Data Narrative_Final.pdf
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- Attached to
- Equipment Operations, Maintenance, and Repair Services at Joint Base Pearl harbor Hickam, Hawaii (JBPHH).
- Solicitation number
- N6247827R2535
About this file
This is Attachment L-3, a Safety Data & Narrative form required for Solicitation No. N6247826R2431. The form is to be completed by offerors to provide safety information for evaluation as part of the Safety factor in the proposal.
Offerors must submit five complete years of reported safety data (2021-2025) including DART (Days Away from Work, Restricted Duty, or Job Transfer) rates and Total Case Incident Rate (TCR) rates, expressed as decimal figures rather than whole numbers. For each year, offerors must submit a completed copy of U.S. Department of Labor OSHA Form 300A (Summary of Work-Related Injuries and Illnesses). Blank entries will be considered non-responsive and may result in an unsatisfactory rating; if no established rates exist for a given year, offerors must annotate the block with "see narrative below" and provide explanation. Offerors must also explain any extenuating circumstances that negatively affect DART or TCR rates. Additionally, offerors must provide a Technical Approach for Safety narrative that does not exceed two pages; any additional pages will not be considered. For Joint Ventures or Mentor-Protégé arrangements, each contractor partner must provide a separate safety data sheet, though only one safety narrative is required. DART and TCR rates shall not be submitted for subcontractors.
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ATTACHMENT L-3 SAFETY DATA & NARRATIVE
ATTACHMENT L-3
SAFETY DATA & NARRATIVE
SOLICITATION NO: N6247826R2431
This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. DART and TC rates shall not be submitted for subcontractors.
Joint Venture (JV)/ Mentor-Protégé (M-P): Provide a safety Data Sheet for each contractor who is part of the JV or M-P; however, only one safety narrative is required.
1. Offeror Name:
Name of Joint Venture/ Mentor-Protégé partner providing the information below (if applicable):
Offeror’s Five Previous (complete) Years of Reported Safety Data:
Only complete year safety data will be considered. Indicate data rates as decimal figures, not whole numbers. NOTE: Blank entries will be considered non-responsive. If you have no established rates, annotate block with “see narrative below.” Any responses with a blank will be considered incomplete and may result in an unsatisfactory rating.
2. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate*
2021 2022 2023 2024 2025
*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.
2a. If you do not have a DART rate for a given year, state so here and explain why:
2b. Explanation of any extenuating circumstances that negatively affect the DART rate:
3. Total Case Incident Rate (TCR)
2021 2022 2023 2024 2025
3a. If you do not have a TCR for a given year, state so here and explain why:
3b. Explanation of any extenuating circumstances that negatively affect the TCR:
4. Provide the Technical Approach for Safety using this form. The Technical Approach for Safety Narrative shall not exceed two pages. Any additional pages will not be considered.
4. (Page 2).
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