36C24125B0003 - EMR Rating Form.pdf
PDF 121 KB Posted
- Attached to
- Z2DA--518-22-111 Elevator Replacement Ph. 3 Federal contract opportunity
- Solicitation number
- 36C24125B0003
About this file
This is an Experience Modification Rate (EMR) form that must be completed and submitted with proposals for an elevator replacement project at the Department of Veterans Affairs. The form requires contractors to provide detailed safety performance data from their OSHA 300 Forms across three years (2022-2024), including man-hours worked, cases involving days away from work or restricted activity, DART rates, and any OSHA violations.
The form stipulates that contractors must provide their NAICS code, identify who administers their Safety and Health Program, and submit their EMR ratings for the past three years. Notable disqualification criteria include having an EMR greater than 1.0, or receiving four serious violations, one repeat violation, or one willful violation from OSHA within the past three years. Contractors must also attach copies of their OSHA 300 and 300a Forms as supporting documentation.
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Text version
EXPERIENCE MODIFICATION RATE (EMR) FORM
OFFEROR TO COMPLETE & SUBMIT WITH PROPOSAL
Company Name:
Address:
Telephone:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2022 2023 2024 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.
(Four serious, one repeat, or one willful disqualifies the contractor.)
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
2. Provide your six-digit North American Industrial Classification System (NAICS) Code for this acquisition:
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of greater than 1.0 may disqualify the offeror):
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .