JM-2_N6945020R0010_Safety_Data_0003.docx
DOCX document 15 KB Posted
- Attached to
- Naval Station Guantanamo Bay Base Operations Support Services Federal contract opportunity
- Solicitation number
- N6945020R0010_Amend_0003
About this file
This document is a safety data sheet template to be completed by offerors responding to solicitation number N69450-20R0010 Amendment 0003 issued by the Department of the Navy Naval Facilities Engineering Command. The template requires offerors to provide safety information including experience modification rates, OSHA DART rates, and total recordable case rates for the previous three calendar years. Offerors must explain any rates above certain thresholds and trends in the rates. Additionally, offerors must provide up to two pages describing their technical approach to safety including plans to evaluate safety performance of potential subcontractors, safety management systems to oversee self-performed and subcontracted work, and methods to ensure safe work practices and facilitate mishap prevention and employee reporting of unsafe conditions at all levels.
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| N6945020R0010_SectionJ-Techncial_Attachments_0003.xlsx | XLSX spreadsheet | |
| GPI-21_NAVSEAOP5_VOLUME1.pdf | ||
| N6945020R0010_SectionJ_0003.pdf | ||
| JL-1_N6945020R0010_GPI Response_0003.pdf | ||
| JL-8_N6945020R0010_SiteVisit_SignIn_Sheets.pdf | ||
| GPI-44_HistoricalData.pdf | ||
| N6945020R0010_J020000013ELINs_0003.xlsx | XLSX spreadsheet | |
| JL-7_N6945020R0010_Site Visit Brief.pdf |
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Text version
SAFETY DATA SHEET
This form is to be completed by the offeror. Use this form to provide safety information for the Safety factor. EMR, 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):
Offeror’s Three Previous Complete Calendar Years of Reported Safety Data:
Only complete year safety data will be considered. Indicate data rates as decimal figures, not whole numbers.
| 2. Experience Modification Rate (EMR): |
| 2018 |
| 2017 |
| 2016 |
2a. Explain any extenuating circumstances resulting in any EMRs greater than 1.0:
2b. Explain any upward or downward EMR trends:
2c. If you do not have an EMR for a given year, state so here and explain why:
| 3. U.S. Dept. of Labor, OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate |
| 2018 |
| 2017 |
| 2016 |
3a. Explain any extenuating circumstances resulting in any DART Rates of 3.0 or greater:
3b. Explain any upward or downward DART Rate trends:
3c. If you do not have a DART Rate for a given year, state so here and explain why:
| 4. Total Recordable Case (TRC) Rate |
| 2018 |
| 2017 |
| 2016 |
4a. Explain any extenuating circumstances resulting in any TRC Rates of 4.5 or greater:
4b. Explain any upward or downward TRC Rate trends:
4c. If you do not have a TRC Rate for a given year, state so here and explain why:
SAFETY DATA SHEET (Continuation)
5. Technical Approach for Safety: Provide the Safety Narrative using this form. Do not exceed 2 pages. Any additional pages will not be considered.
Describe the plan for safety that will be implemented to evaluate safety performance of potential subcontractors as a part of the selection process for all levels of subcontractors:
Fully describe the safety management system that will be used to oversee the safety compliance and performance of self-performed and subcontract performed work.
Describe any innovative methods that will be employed to ensure and monitor safe work practices at self-performed and/or all subcontractor levels:
Describe the methodology to execute an effective program that facilitates sound mishap prevention techniques and processes, employee reporting of unsafe conditions, unsafe activities, and near-miss mishaps.
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