A013 - Accident Incident Report
PDF 676 KB Posted
- Attached to
- M31 FIN RFP W15QKN-19-R-0015
- Solicitation number
- W15QKN-19-R-0015
About this file
This document is a Contract Data Requirements List (CDRL) detailing the reporting requirements for any accident or incident reports related to Federal Contract Number W15QKN-19-R-0015 issued by the Department of the Army Materiel Command Contracting Command Picatinny Arsenal. The CDRL requires immediate electronic notification to the contracting office and other listed parties in the event of any accident or incident resulting in fatalities, disabling injuries, property damage exceeding $10,000, or any potential safety hazards. Accident or incident reports must include details of the event such as location, summary with pertinent details, cause, casualties, property damage estimates, production effects, contractor actions taken, and any additional information. For equipment malfunctions, the report must also include the equipment nomenclature, quantities involved, and production lot numbers along with a brief technical description of the malfunction.
CDRL A013
View the file
Other files
Show all 36
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
DD FORM 1423-1, FEB 2001 PREVIOUS EDITIONS MAY BE USED Page____of____
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
Form Approved OMB No. 0704-0188
The public reporting burden for this collection of information is estimated to average 110 hours per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing the burden, to the Department of Defense, Executive Services Directorate (0704-0188). Respondents should be aware that notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does not display a currently valid OMB control number. Please do not return your form to the above organization. Send completed form to the Government Issuing Contracting Officer for the Contract/PR No. listed in Block E.
A. CONTRACT LINE ITEM NO. B. EXHIBIT C. CATEGORY
TDP _______ TM _______ OTHER ____________________________
D. SYSTEM/ITEM E. CONTRACT/PR NO. F. CONTRACTOR
1. DATA ITEM NO. 2. TITLE OF DATA ITEM 3. SUBTITLE
4. AUTHORITY (Data Acquisition Document No.) 5. CONTRACT REFERENCE 6. REQUIRING OFFICE
7. DD 250 REQ 9. DIST STATEMENT REQ’D 10. FREQUENCY 12. DATE OF FIRST SUBMISSION 14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
8. APP CODE 11. AS OF DATE 13.13. DATE OF SUBSEQUENT SUBMISSION
Draft Final
Reg Repro
16. REMARKS
15. TOTAL
G. PREPARED BY H. DATE I. APPROVED BY J. DATE
| 1 DATA ITEM NO: A013 |
| 2 TITLE OF DATA ITEM: Accident/Incident Report |
| 3 SUBTITLE: |
| 5 CONTRACT REFERENCE: C.9.6 |
| 6 REQUIRING OFFICE: SFAE-AMO-CAS |
| 7 DD 250 REQ: LT |
| 9 DIST STATEMENT REQD: D |
| 10 FREQUENCY: As Required |
| 12 DATE OF FIRST SUBMISSION: As Required |
| 11 AS OF DATE: As Required |
| 13 DATE OF SUBSEQUENT SUBMISSION: As Required |
| a ADDRESSEERow1: ACC-NJ-CA |
| DraftRow1: 1 |
| RegRow1: 1 |
| ReproRow1: |
| a ADDRESSEERow2: RDAR-MEA-P |
| DraftRow2: 1 |
| RegRow2: 1 |
| ReproRow2: |
| a ADDRESSEERow3: RDAR-EIQ-PE |
| DraftRow3: 1 |
| RegRow3: 1 |
| ReproRow3: |
| a ADDRESSEERow4: Government QAR |
| DraftRow4: 1 |
| RegRow4: 1 |
| ReproRow4: |
| a ADDRESSEERow5: SFAE-AMO-CAS |
| DraftRow5: 1 |
| RegRow5: 1 |
| ReproRow5: |
| a ADDRESSEERow6: RDAR-EIQ-MC |
| DraftRow6: 1 |
| RegRow6: 1 |
| ReproRow6: |
| a ADDRESSEERow7: |
| DraftRow7: |
| RegRow7: |
| ReproRow7: |
| a ADDRESSEERow8: |
| DraftRow8: |
| RegRow8: |
| ReproRow8: |
| a ADDRESSEERow9: |
| DraftRow9: |
| RegRow9: |
| ReproRow9: |
| a ADDRESSEERow10: |
| DraftRow10: |
| RegRow10: |
| ReproRow10: |
| a ADDRESSEERow11: |
| DraftRow11: |
| RegRow11: |
| ReproRow11: |
| a ADDRESSEERow12: |
| DraftRow12: |
| RegRow12: |
| ReproRow12: |
| a ADDRESSEERow13: |
| DraftRow13: |
| RegRow13: |
| ReproRow13: |
| a ADDRESSEERow14: |
| DraftRow14: |
| RegRow14: |
| ReproRow14: |
| a ADDRESSEERow15: |
| DraftRow15: |
| RegRow15: |
| ReproRow15: |
| a ADDRESSEERow16: |
| DraftRow16: |
| RegRow16: |
| ReproRow16: |
| a ADDRESSEERow17: |
| DraftRow17: |
| RegRow17: |
| ReproRow17: |
| a ADDRESSEERow18: |
| DraftRow18: |
| RegRow18: |
| ReproRow18: |
| a ADDRESSEERow19: |
| DraftRow19: |
| RegRow19: |
| ReproRow19: |
| a ADDRESSEERow20: |
| DraftRow20: |
| RegRow20: |
| ReproRow20: |
| a ADDRESSEERow21: |
| DraftRow21: |
| RegRow21: |
| ReproRow21: |
| a ADDRESSEERow22: |
| DraftRow22: |
| RegRow22: |
| ReproRow22: |
| a ADDRESSEERow23: |
| DraftRow23: |
| RegRow23: |
| ReproRow23: |
| a ADDRESSEERow24: |
| DraftRow24: |
| RegRow24: |
| ReproRow24: |
| a ADDRESSEERow25: |
| DraftRow25: |
| RegRow25: |
| ReproRow25: |
| a ADDRESSEERow26: |
| DraftRow26: |
| RegRow26: |
| ReproRow26: |
| Draft15 TOTAL: 6 |
| Reg15 TOTAL: 6 |
| Repro15 TOTAL: |
| H DATE: 28 Mar 2018 |
| J DATE: 28 Mar 2018 |
| A CONTRACT LINE ITEM NO: |
| B EXHIBIT: |
| TDP: X |
| TM: |
| OTHER: |
| D SYSTEMITEM: M31 Fin for 120MM Mortar Cartridges |
| E CONTRACTPR NO: |
| F CONTRACTOR: |
| Pg: |
| Remarks: This report provides the procuring agency with immediate notification and information concerning any major accident/incident (including fire) resulting in any one or more of the following: causing one or more fatalities, or two or more disabling injuries; damaging government property exceeding $10,000; affecting program planning or production schedules; degrading the safety of the equipment under contract, such that personnel injury or property damage may be involved; identifying a potential hazard requiring corrective action. |
Contractor format is acceptable.
Report without delay any serious accident or incident (i.e. explosion, fire, flood, pressure rupture, major malfunction) which will adversely affect capability to meet contractual obligations.
The report shall be made by the fastest means, giving the following information: Name, organization, telephone number, and location of the contractor and general manager; Name and title of the person(s) reporting; Date and time of accident/incident; Location of accident/incident (i.e., building number, facility name); Brief summary of accident/incident giving pertinent details including type and quantity of matériel; Cause of accident/incident; Casualties (fatalities, disabling injuries, exposed to CBR agents); Estimated property damage, if applicable; Nature of damage; effect on production, operations, training or other activity; Action taken by contractor; Other damage or injuries sustained (public or private); Other pertinent information.
If a malfunction of equipment is involved, the following additional information shall be furnished: Equipment nomenclature; Quantity involved; Production lot number(s); Brief technical description of malfunction.
BLOCK 14: Submit electronically. E-mail addresses for the listed offices will be provided at Contract/Post award.
| 2018-03-28T07:34:45-0400 | |
| CHAMBERS.DARRIN.S.1367772740 |
| 2018-03-28T07:34:35-0400 | |
| CHAMBERS.DARRIN.S.1367772740 |
| 8 APP CODE: |
| 4 AUTHORITY Data Acquisition Document No: N/A |
File details come from the government source that posted it. Updated .