Instructions for Supply Chain Management and Environmental Safety and
Health review and approval of Form 540.12, Subcontractor Safety and
Health Data.

1.  **[Responsibilities]{.underline}**

    1.  [Subcontract Technical Authority (STA]{.underline}): Assisted by
        the Subcontract Administrator (SA) and the area Environmental
        Safety & Health (ES&H) representative, review and classify the
        work scope as minor maintenance or complex/hazardous in
        accordance with LWP-4002 Appendix N.

        1.  Determine if Section I or Sections I and II of form 540.12
            will be required from the offeror and what additional
            documentation will be submitted for review and approval.

    2.  [Subcontract Administrator]{.underline}: Issue the
        solicitation/RFP with instructions that completion and submittal
        of form 540.12 may be required.

        1.  Obtain the completed form 540.12 and required supporting
            documentation from the low evaluated offeror.

        2.  Forward the 540.12 submittal to the Safety & Health
            Representative responsible for the area where work will be
            performed.

    3.  [ES&H Representative]{.underline}: Review the OSHA Logs and
        Summary and calculate the incidence rates on the 540.12 for each
        of the 3 previous years.

        1.  Evaluate the data submitted and determine if the offeror is
            "Not Approved", "Approved" or receives a Level 1 or Level 2
            "Conditional Approval" to work on the INL. Indicate the
            determination in the **FOR CONTRACTOR USE ONLY** section of
            the form 540.12 accordingly and return with all
            documentation to the SA.

        2.  If the offeror is not approved for safety and health
            reasons, mark "Not Approved" and identify the reason(s) for
            non-approval.

        3.  If the submittals are acceptable, designate the status of
            the offeror in accordance with the status positions defined
            in this document.

            1.  If the offeror has been determined to be approved, mark
                "Approved" and indicate the section i.e. Section I Only
                or Sections I and II.

            2.  If the offeror has been determined to receive a
                Conditional Approval, mark "Conditional Approval" and
                designate the Level as either 1 or 2. Also, mark
                Sections I and II.

                1.  Indicate on the form any specific conditions which
                    must be met by the offeror to work at the INL.
                    Conditions should be identified to mitigate
                    potential risk for offerors.

                2.  Ensure that the offeror has completed Section II
                    Programs and Information.

                3.  Ensure that a corrective action plan that includes
                    the following is submitted and approved.

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a.  Identify what the offeror will implement as a part of the
    subcontract to improve their safety program in areas that include
    but are not limited to: management accountabilities, employee
    involvement, work control process, project goals, safety awareness,
    training and stop work.

b.  Include positive steps that will be taken to ensure safe operation
    at the INL. This may include special training, required oversight by
    a Certified Safety Professional/Certified Industrial Hygienist, or
    other program elements deemed necessary to support a zero accident
    philosophy.

    1.  Level 1 Conditional Approval requires review and approval of the
        form and the Corrective Action Plan by the Occupational Safety
        and Health Director.

    2.  Level 2 Conditional Approval requires review and approval of the
        form and the Corrective Action Plan by the Occupational Safety
        and Health Director and General Manager/ESH&QA.

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    1.  Return the signed form 540.12 and all supporting documentation
        to the SA.

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    1.  [Subcontract Administrator]{.underline}: Notify the offeror of
        the results of the evaluation and the resulting status
        determination.

        1.  Incorporate any specific conditions identified by ES&H into
            the subcontract and award.

        2.  Forward all original documents to the Procurement Records
            Coordinator.

    2.  [Procurement Records Coordinator]{.underline}: Open and maintain
        a file for each approved offeror.

        1.  Add approved offerors to the pre-approved suppliers list.

+------------------------------------------------------+----+----------+
| **STATUS POSITIONS:**                                |    |          |
+------------------------------------------------------+----+----------+
| **Approved:** If the EMR, TRCR and LWCR are at or    | E  | .88 or   |
| below the level identified, the offeror is approved  | MR | lower    |
| for on-site work.                                    |    |          |
+------------------------------------------------------+----+----------+
|                                                      | TR | 3.5 or   |
|                                                      | CR | lower    |
+------------------------------------------------------+----+----------+
|                                                      | LW | 2.5 or   |
|                                                      | CR | lower    |
+------------------------------------------------------+----+----------+
|                                                      |    |          |
+------------------------------------------------------+----+----------+
| **Conditional Approval Level 1:** If the EMR, TRCR   | #  | 1.0 or   |
| and LWCR are at or below the level identified, the   | ## | lower    |
| offeror will be required to meet additional          | ## |          |
| conditions to perform work on-site.                  | ## |          |
|                                                      |  E |          |
|                                                      | MR |          |
+------------------------------------------------------+----+----------+
|                                                      | TR | 7.5 or   |
|                                                      | CR | lower    |
+------------------------------------------------------+----+----------+
|                                                      | LW | 4.0 or   |
|                                                      | CR | lower    |
+------------------------------------------------------+----+----------+
|                                                      |    |          |
+------------------------------------------------------+----+----------+
| **Conditional Approval Level 2:** If the EMR, TRCR   | E  | greater  |
| and LWCR are above the level identified, the offeror | MR | than 1.0 |
| will be required to meet additional conditions to    |    |          |
| perform work on-site.                                |    |          |
+------------------------------------------------------+----+----------+
|                                                      | TR | greater  |
|                                                      | CR | than 7.5 |
+------------------------------------------------------+----+----------+
|                                                      | LW | greater  |
|                                                      | CR | than 4.0 |
+------------------------------------------------------+----+----------+
| **DEFINITIONS:**                                     |    |          |
|                                                      |    |          |
| ***Experience Modification Rate (EMR)*:** An         |    |          |
| adjustment to the workers' compensation experience.  |    |          |
| An experience modifier of 1.00 is the expected       |    |          |
| average for a given contractor and reflects the cost |    |          |
| of losses expected for a contractor that employs the |    |          |
| various trades.                                      |    |          |
|                                                      |    |          |
| ***Incidence rates:***                               |    |          |
|                                                      |    |          |
| An incidence rate of injuries and/or illnesses cases |    |          |
| related to a common exposure base can be computed    |    |          |
| from the formula below. This enables one to make     |    |          |
| accurate industry comparisons and trend analysis     |    |          |
| among firms regardless of size. The same formula     |    |          |
| with a varying **N** defined variable is used to     |    |          |
| compute different incidence rates and is calculated  |    |          |
| as follows:                                          |    |          |
|                                                      |    |          |
| ### **[N x 200,000]{.underline}**                    |    |          |
|                                                      |    |          |
| ### **EH**                                           |    |          |
|                                                      |    |          |
| Where:                                               |    |          |
|                                                      |    |          |
| **EH** = Total hours worked by all employees during  |    |          |
| calendar year.                                       |    |          |
|                                                      |    |          |
| **200,000** = Represents the equivalent of 100       |    |          |
| full-time employees working 40 hours per week, 50    |    |          |
| weeks per year, and provides the standard base for   |    |          |
| the incidence rates.                                 |    |          |
|                                                      |    |          |
| **TRCR**, Total Recordable Case Rate, is calculated  |    |          |
| as:                                                  |    |          |
|                                                      |    |          |
| ### **[N x 200,000]{.underline}**                    |    |          |
|                                                      |    |          |
| ### **EH**                                           |    |          |
|                                                      |    |          |
| Where:                                               |    |          |
|                                                      |    |          |
| **N** = Number of total OSHA recordable injuries     |    |          |
| and/or illnesses cases to inlcude those with lost    |    |          |
| workday(s), job transfer and/or restriction, and     |    |          |
| other.                                               |    |          |
|                                                      |    |          |
| **LWCR**, Lost Workday Case Rate, is calculated as:  |    |          |
|                                                      |    |          |
| ### **[N x 200,000]{.underline}**                    |    |          |
|                                                      |    |          |
| ### **EH**                                           |    |          |
|                                                      |    |          |
| Where:                                               |    |          |
|                                                      |    |          |
| **N** = Number of total OSHA recordable injuries     |    |          |
| and/or illness cases with lost workday(s).           |    |          |
+------------------------------------------------------+----+----------+