Attachment L-3 Safety Data Narrative

ATTACHMENT L-3 SAFETY DATA & NARRATIVE

ATTACHMENT L-3

SAFETY DATA & NARRATIVE

SOLICITATION NO: N6247826R2431

This form is to be completed by the Offeror. Use this form to provide safety information for the Safety factor. DART and TC rates shall not be submitted for subcontractors. Joint Venture (JV)/ Mentor-Protégé (M-P): Provide a safety Data Sheet for each contractor who is part of the JV or M-P; however, only one safety narrative is required.

1. Offeror Name:

Name of Joint Venture/ Mentor-Protégé partner providing the information below (if applicable): Offeror’s Five Previous (complete) Years of Reported Safety Data: Only complete year safety data will be considered. Indicate data rates as decimal figures, not whole numbers. NOTE: Blank entries will be considered non-responsive. If you have no established rates, annotate block with “see narrative below.” Any responses with a blank will be considered incomplete and may result in an unsatisfactory rating. 2021
2022
2023
2024
2025
2. U.S. Dept. of Labor, OSHA Days
Away from Work, Restricted Duty,
or Job Transfer (DART) Rate*
*For each year, submit a completed copy of U.S. Dept. of Labor, OSHA Form 300A (Summary of Work-Related Injuries and Illnesses), latest version. This information is required regardless of number of employees in the company.
2a. If you do not have a DART rate for a given year, state so here and explain why:

2b. Explanation of any extenuating circumstances that negatively affect the DART rate:

2021

2022

2023

2024

3. Total Case Incident Rate (TCR)

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

3b. Explanation of any extenuating circumstances that negatively affect the TCR:

2025

4. Provide the Technical Approach for Safety using this form. The Technical Approach for Safety Narrative shall not exceed two pages. Any additional pages will not be considered.

4. (Page 2).