80712 - Contract Data Requirements List A004 - Contractor Safety Plan

CONTRACT DATA REQUIREMENTS LIST

Form Approved

OMB No. 0704-0188

(1 Data Item)

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

0004

C. CATEGORY:

A

D. SYSTEM/ITEM

E. CONTRACT/PR NO.

X

F. CONTRACTOR

HALON ANALYZER

1. DATA ITEM NO.

A004

3. SUBTITLE

Contractor's Safety Plan

Safety Plan

4. AUTHORITY (Data Acquisition Document No.)

5. CONTRACT REFERENCE

DI-SAFT-82080/T NOT 2

7. DD 250 REQ

NO

8. APP CODE

A

17. PRICE GROUP

2. TITLE OF DATA ITEM

9. DIST STATEMENT

REQUIRED

A

10. FREQUENCY

12. DATE OF FIRST SUBMISSION

1TIME

WR-ALC/SE (Safety Office)
14.

DISTRIBUTION

SEE BLK 16

13. DATE OF SUBSEQUENT

SUBMISSION

11. AS OF DATE

b. COPIES

a. ADDRESSEE

SEE BLK 16

N/A

18. ESTIMATED

TOTAL PRICE

6. REQUIRING OFFICE

PD Para 4.12.1

16. REMARKS

See blk 16

Final

Draft

Reg

Repro

BLK 12: Submit draft of company safety plan for review/approval within 10 working days after contract award to [email protected]. Government will have 5 working days to review and return if any changes are noted. If no changes are made or if government does not reply in 5 working days then the draft will be considered the final. Safety plan can be in Contractor format electronically sent. Also submit the Appendix C that was supplied by the Government and annotate in the Appendix C anything the Contractor does not believe is applicable to the type of work to be performed.
BLK 13: Submit final copies 10 working days after Government (WR-ALC/SE) acceptance of draft. Revisions as required.

BLK 14a:

WR-ALC/SE

Workflow:
[email protected]
Primary Govt POC: Michael Tew, [email protected]
Alternate Govt POC: Della Smith, [email protected]
CSMO/WAWF Primary: Dustin Knowles, [email protected]