Attachment 1: Encl 3. Safety AMD0002

SAFETY NARRATIVE

Use this form to provide the Safety Narrative. Individual blocks on this form may be expanded; however, total length shall not exceed one (1) double-sided page (or two (2) single-sided pages). For Joint Ventures, only one safety narrative is required. Additional pages will not be considered.

OFFEROR NAME:

1. Submit the numbers of Labor Hours (Hrs) and Fatality (death), Lost Work Day (Lost D) and No-Lost Work Day (No- Lost D) cases using the table below. Fill in highlighted boxes below. Calendar Year (Jan-Dec)
2021
2022
2023
2024
2025
① Labor Hrs
② Fatality
③ Lost D
④ No-Lost D
a. If the Offeror has no data, for any year, affirmatively state so and explain why.

b. Any fatalities (death cases) experienced within this 5-year period must be explained in detail to include root cause and corrective actions.

2. Describe the Offeror’s approach to implementing and executing a Safety Management System (SMS) including 1) Management/Leadership involvement, 2) Employee involvement, 3) Hazard prevention, 4) Hazard control, 5) Worksite analysis, and 6) Safety and health training, to include the standard(s) used to benchmark the SMS.

3. Describe the evaluation process used to select potential subcontractors.

4. 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 employees).