MIOSS_Exhibit_A_B001_CDRL_Accident-Incident_Report.pdf
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- Attached to
- The Medical Simulation Training Center (MSTC), Instructor, Operator Support Services (MIOSS) acquisition
- Solicitation number
- W900KK-23-R-0016
About this file
This Contract Data Requirements List (CDRL) requires the submission of accident and incident reports related to medical simulation training. The reports must be provided immediately upon an accident/incident, within 72 hours of the event, and revised submissions with close-out actions are due ten days after closure. The reports are to be delivered electronically in Microsoft Office format with email notification to the Procuring Contracting Officer. Distribution of the reports is restricted to U.S. Government agencies.
Solicitation W900KK-23-R-0016 is for instructor and operator support services for the Medical Simulation Training Centers. The services involve education and training but not direct treatment of patients. The fixed-price contract will have a two-month phase-in, six-month base period, and four one-year options. This is a small business set-aside for NAICS code 541990 with a size standard of $16.5M. The solicitation incorporates FAR provisions and clauses through FAC 2005-95. Offerors must review the website for amendments to the solicitation, as hard copies will not be provided.
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Text version
DD FORM 1423-1, FEB 2001
CONTRACT DATA REQUIREMENTS LIST
(1 Data Item)
PREVIOUS EDITION MAY BE USED.
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 and Communications 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
8. APP CODE
9. DIST STATEMENT
REQUIRED
10. FREQUENCY
11. AS OF DATE
12. DATE OF FIRST SUBMISSION
13. DATE OF SUBSEQUENT
SUBMISSION
14. DISTRIBUTION
a. ADDRESSEE
b. COPIES
Draft Final
Reg Repro
15. TOTAL
16. REMARKS
17. PRICE GROUP
18. ESTIMATED
TOTAL PRICE
H. DATE J. DATE
Page of Pages
B
SAFT
OSS W900KK
B001 ACCIDENT/INCIDENT REPORT
DI-SAFT-81563 SEE BLK 16 SFAE-STRI-
LT
N/A B
AS REQ
SEE BLK 16
SEE BLK 16
SEE BLK 16
SEE BLK 16
0 0 0
BLOCK 5: BASE PWS PARAGRAPH 2.19.1.
BLOCK 8: THE GOVERNMENT WILL HAVE FIVE (5) WORKING DAYS
FOR REVIEW AND ACCEPTANCE OR REJECTION OF EACH
SUBMISSION. THE CONTRACTOR SHALL HAVE FIVE (5) WORKING
DAYS TO INCORPORATE GOVERNMENT COMMENTS AND RESUBMIT.
BLOCK 9: DISTRIBUTION AUTHORIZED TO U.S. GOVT AGENCIES
ONLY. OTHER REQUESTS MUST BE REFERRED TO PEO STRI
(SFAE-STRI- ).
WARNING: THIS DOCUMENT CONTAINS TECHNICAL DATA WHOSE
EXPORT IS RESTRICTED BY THE ARMS EXPORT CONTROL ACT (TITLE
22, U.S.C., SEC. 2751, ET SEQ.) OR THE EXPORT ADMINISTRATION ACT
OF 1979, AS AMENDED (TITLES 50, U.S.C., APP. 2401, ET SEQ.)
VIOLATION OF THESE EXPORT LAWS ARE SUBJECT TO SEVERE
CRIMINAL PENALTIES. DISSEMINATE IN ACCORDANCE WITH THE
PROVISIONS OF DOD DIRECTIVE 5230.25.
BLOCK 10: AS REQUIRED, SHALL BE DUE IMMEDIATELY UPON
COMPLETING AN ACCIDENT/INCIDENT REPORT.
BLOCK 11: DATE OF ACCIDENT/INCIDENT BEING REPORTED.
BLOCK 12: AS REQUIRED, SHALL BE DUE WITHIN 72 HOURS OF THE
ACCIDENT/INCIDENT.
BLOCK 13: REVISED SUBMISSION, CONTAINING CLOSE-OUT
ACTIONS (LEGAL AND ADMINISTRATIVE, AS APPLICABLE) SHALL BE
DUE TEN (10) DAYS AFTER ACCIDENT/INCIDENT CLOSURE.
BLOCK 14a: PCO COR
BLOCK 14b: SHALL BE DELIVERED IN MICROSOFT OFFICE FORMAT WITH AN EMAIL NOTIFICATION TO BLK 14a.
G. PREPARED BY I. APPROVED BY
7/14/2022 14 JUL 2022STROUD.FRANKLIN
.GLENN.1202177472
Digitally signed by
STROUD.FRANKLIN.GLENN.120217
Date: 2022.07.14 13:50:21 -04'00'
STEVENS.DARIN.
OWEN.1186676773
Digitally signed by
STEVENS.DARIN.OWEN.118667
Date: 2022.07.14 15:59:11 -04'00'
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