DI-SAFT-81563
Accident/Incident Report
This Data Item Description details requirements for immediate notification and information regarding major accidents or incidents involving fatalities, disabling injuries, property damage, or impacts to program schedules and equipment safety.
Approval DateJune 2, 1998
AMSC NumberA7315
Preparing Activity—
Project Number—
OPRA/AR
DTIC Applicable—
GIDEP Applicable—
Limitation—
Applicable Forms—
Approval Limitation—
Form Version—
DID Formatdd_form_1664
963C CompliantNo
DISTRIBUTION STATEMENT A: Approved for public release; distribution is unlimited.
Application & Interrelationship
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Use & Relationship
This report provides the procuring agency with immediate notification and information concerning any major accident/incident (including fire) resulting in any one or more of the following: causing one or more fatalities, or two or more disabling injuries; damaging government property exceeding $10,000; affecting program planning or production schedules; degrading the safety of the equipment under contract, such that personnel injury or property damage may be involved; identifying a potential hazard requiring corrective action.
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.
Preparation Instructions
1Format.Contractor format is acceptable
2Content.Report without delay any serious accident or incident (i.e. explosion, fire, flood, pressure rupture, major malfunction) which will adversely affect capability to meet contractual obligations. The report shall be made by the fastest means, giving the following information.
2.1Name, organization, telephone number, and location of the contractor and general manager
2.2Name and title of the person(s) reporting
2.3Date and time of accident/incident
2.4Location of accident/incident, i.e., building number, facility name
2.5Brief summary of accident/incident giving pertinent details including type and quantity of materiel
2.6Cause of accident/incident
2.7Casualties (fatalities, disabling injuries, exposed to CBR agents)
2.8Estimated property damage, if applicable
2.9Nature of damage; effect on production, operations, training or other activity
2.10Action taken by contractor
2.11Other damage or injuries sustained (public or private)
2.12Other pertinent information
3Malfunction. If a malfunction of equipment is involved, the following additional information shall be furnished:
3.1Equipment nomenclature
3.3Production lot number(s)
3.4Brief technical description of malfunction
Schema v3.0Community-maintained · Verify against ASSIST 