22) CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD EVALUATION FORM.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77621B0006
About this file
This document contains a Contractor Safety and Environmental Record Evaluation Form and details of a related federal contract opportunity for construction services. The evaluation form requests safety and environmental record information from contractors, including OSHA recordable incidents from 2017 to 2020, daily rates, and any serious violations. The related federal contract opportunity is a solicitation from the Department of Veterans Affairs for construction phase one services to renovate the building enclosure and interior demolition of a training and administration building at the Hines VA Medical Center in Illinois. The solicitation number is 36C77621B0006 and responses are due by February 22, 2021. The opportunity is set aside for Service-Disabled Veteran-Owned Small Businesses and has a North American Industry Classification System code of 236220 for commercial and institutional building construction with a size standard of $39.5 million. The period of performance is approximately 120 calendar days.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621B0006 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2017 |
| 2018 |
| 2019 |
| 2020 |
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
File details come from the government source that posted it. Updated .