Attch 10 EMR 1 Page.pdf

This is a Pre-Award Contractor Evaluation Form (EMR Form) that bidders and offerors must complete and submit with their proposals for federal contract opportunities.

The form requires contractors to provide standard company information including name, address, telephone, fax, email, and primary contact. Contractors must complete an OSHA 300 Forms summary covering four years (2022-2025) that documents: total man hours worked at jobsite and office locations; number of cases involving days away from work, restricted activity, or both; the Days Away, Restricted, or Transferred (DART) rate calculated as the number of applicable cases multiplied by 200,000 divided by total man hours; and the number of serious, willful, or repeat violations from OSHA within the past three years with required explanations. Contractors must also provide their six-digit North American Industrial Classification System (NAICS) code, identify who administers their company's Safety and Health Program, and disclose their Insurance Experience Modification Rate (EMR) for the past three years. The form specifies that an EMR greater than 1.0 disqualifies the contractor, and that four serious violations, one repeat violation, or one willful violation within the three-year period also results in disqualification. Copies of OSHA 300 and 300a Forms must be attached to the submission, which can be accessed through the OSHA publications search page.