DATA ITEM DESCRIPTION
Title: Accidertflncident Report
Number DI-SAFT-81563
Approved Date: 2 Jun98
AMSC Numbec A7315
Limitation:
DT3C Applicable:
GIDEP Application:
Office of Primary Respomibility A/AR
Applicable Fornw
Use/relationship: ThisreportprovidestAeprocuring agency with immediate notification and
information concerning any mrjor acciderrthncident (including fire) resulting in any one or more of
the following: causing one or more fatalities, or two or snoredisabling injuries; damaging
government property exceeding $10,000; atTecting program planning or production schedules;
degrading the safety of the equipment under contract, such that persomel injury or property darnage
may be involved, identi@ng a potential hazard requiring corrective action.
a. This Data Item Description contains the format and content preparation instructions for the data
product generated by the specific and discrete task requirement as delineated in the contract.
b. This Data Item Description replaces DI-H-I 329A.
Requirements:
1. Format. Contractor format is acceptable
2. Content. Report without delay any serious accident or incident (i.e. explosioq fire, flood
pressure rupture, major rndfunction) which will adversely affect capabtity to meet contractual
obligations. The report shall be made by the fkstest means, giving the following information.
:
c.
d.
e.
f.
::
i.
1.
Name, organization, telephone number, and location of the contractor and general manager
Name and title of the person(s) reporting
Date and time of accidenthcident
Location of accidentiiciden~ i.e., building number, fkcility name
Brief summary of accidentkscidcnt giving pertinent details”iircludihgtype ‘md qtiti~”of -
materiel
Cause of accidentliicident
Camalties (fatalities, disabling irjuries, exposed to CBR agents)
Estimated property damage, if applicable
Nature of darnage; effect on production, operations, training or other activity
Action taken by contractor
Other damage or injuries sustained (public or private)
Other pertinent information
Downloaded from http://www.everyspec.com
