Safety_Data_Sheet.docx
DOCX document 15 KB Posted
- Attached to
- Bldg. 1074 HVAC Modification Federal contract opportunity
- Solicitation number
- N00253-22-R-0033
About this file
This document contains a safety data sheet template for a federal contract opportunity to replace and install HVAC equipment at Building 1074 for the Naval Sea Systems Command. The safety data sheet requests offerors to provide insurance information and OSHA DART and TCR rates for the previous five years, along with explanations for any safety rate trends above moderate risk levels. Offerors must also submit a two-page safety narrative describing their safety management system, subcontractor evaluation process, and oversight of subcontractor safety compliance. The related federal contract opportunity is solicitation number N00253-22-R-0033 to replace an air handling unit and install five ductless split systems at Building 1074 to modify the HVAC system.
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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. 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. Insurance Carrier Information:
Insurance Carrier Name:
Agent’s name:
Phone No.:
Email:
Offeror’s Five 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.
3. OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) Rate
| 2016 |
| 2017 |
| 2018 |
| 2019 |
| 2020 |
3a. If you do not have a DART Rate for a given year, affirmatively state so here and explain why:
3b. Explain any negative trend above moderate risk (DART Rates of 3.0 or greater), an acceptable/detailed explanation is required that includes any corrective actions taken for improvement:
4. Total Recordable Case (TCR) Rate
| 2016 |
| 2017 |
| 2018 |
| 2019 |
| 2020 |
4a. If you do not have a TCR Rate for a given year, affirmatively state so here and explain why:
4b. Explain any negative trend above moderate risk (TCR Rates of 4.5 or greater), an acceptable/detailed explanation is required that includes any corrective actions taken for improvement:
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.
a. 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.
b. Describe the evaluation process used to select potential subcontractors.
c. 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).
File details come from the government source that posted it. Updated .