Wet Utilities Safety_Data.docx

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Wet Utilities Job Order Contract-Multiple Locations Federal contract opportunity
Solicitation number
N40080-21-R-9503
Issued by
Department of the Navy Naval Facilities Engineering Command

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NRL CARD_WET UTILITIES JOC Sources Sought AMD01.docx DOCX document
NRL CARD_WET UTILITIES JOC Sources Sought.docx DOCX document

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SAFETY DATA SHEET

1. Respondent:

Most Recent Complete Calendar Years of Reported Safety Data:

Indicate data rates as decimal figures, not whole numbers.

2. Experience Modification Rate (EMR):
Year-20XX
Year-20XX
Year-20XX

2a. For EMRs greater than 1.0, explain any extenuating circumstances and corrective actions taken:

2b. Explain any negative 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
Year-20XX
Year-20XX
Year-20XX

Instructions for calculating the DART rate can be found at http://www.bls.gov/iif/osheval.htm.

3a. For DART Rates of 3.0 or greater, explain any extenuating circumstances and corrective actions taken:

3b. Explain any negative DART Rate trends:

3c. If you do not have a DART Rate for a given year, state so here and explain why:

Note: Form may be expanded.

(continuation)

SAFETY NARRATIVE

4. U.S. Dept. of Labor, OSHA Total Recordable Case (TRC) Rate
Year-20XX
Year-20XX
Year-20XX

Instructions for calculating the TRC rate can be found at http://www.bls.gov/iif/osheval.htm.

4a. For TRC Rates of 4.5 or greater, explain any extenuating circumstances and corrective actions taken:

4b. Explain any negative TRC Rate trends:

4c. If you do not have a TRC Rate for a given year, state so here and explain why:

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