+-------------------------+--------------+---------+-------------------+
| 1\. DRD Title           | 2\. Date of  | 3\. DRL | RFP/Contract No.  |
|                         | current      | Line    | (*Procurement     |
| **Accident / Incident   |              |         | completes*)       |
| Summary Report**        | version      | Item    |                   |
|                         |              | No.     | NAS 9-18181       |
|                         | October 2001 |         |                   |
|                         |              | 85      |                   |
+-------------------------+--------------+---------+-------------------+
| 4\. Use (*Define need   |              |         | 5\. DRD category: |
| for, Intended use of,   |              |         | (*check one*)     |
| and/or anticipated      |              |         |                   |
| results of data*)       |              |         | € Technical       |
|                         |              |         |                   |
| Monthly summary safety  |              |         | € Administrative  |
| data to be used to      |              |         |                   |
| evaluate contractor's   |              |         | x SR & QA         |
| safety and health       |              |         |                   |
| program performance     |              |         |                   |
+-------------------------+--------------+---------+-------------------+
| 6\. References          | 7\.          |         |                   |
| (*Optional*)            | Interr       |         |                   |
|                         | elationships |         |                   |
| **NHB 1700.1; JHB       | (*e.g., with |         |                   |
| 1700.1;**               | other DRDs*) |         |                   |
|                         | (*Optional*) |         |                   |
| **JSC Form 288**        |              |         |                   |
|                         | **81**       |         |                   |
+-------------------------+--------------+---------+-------------------+

8\. Preparation Information (*Include complete Instructions for document
preparation*)

A. The contractor shall prepare and deliver Accident/Incident Summary
Reports as documented and approved in the Safety and Health Plan.

B. Information required:

> 1\. All information specified on JSC Form 288, \"Accident / Incident
> Statistics\" , as revised.
>
> 2\. All accidents, including vehicle accidents, incidents, injuries,
> fires, and close calls shall be reported in summary form.
>
> 3\. Negative reports which include hours worked are also required
> monthly.
>
> 4\. The report should include a brief description of safety activities
> that have been accomplished during the past month with follow-on
> action anticipated for the following month.

C. Format - The attached JSC Form 288, Accident/Incident Statistics, is
representative of a format acceptable to NASA and contains the minimum
amount of information to be transmitted.

D. Report to be delivered to the JSC Safety, Reliability, and Quality
Assurance Office.

Authority. NFS 18-52.223-70, 18-52.223-73, 18-52.223-73 (Alt 1); JPI
52.223-92