Attachment 19 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.

The form requires contractors to provide company identification information including name, address, telephone, fax, email, and primary contact. Contractors must complete OSHA 300 Forms data for four years (2022-2025) documenting: total man hours worked at jobsites and offices; number of cases involving days away from work, restricted activity, or both; days away, restricted, or transferred rate (DART Rate) calculated as the number of 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 explanations for violations. Contractors must also provide their six-digit North American Industrial Classification System (NAICS) Code, identify who administers the company's Safety and Health Program, and report the company's Insurance Experience Modification Rate (EMR) for the past three years. A disqualifying condition exists if the company has four serious violations, one repeat violation, one willful violation, or an EMR greater than 1.0. Copies of OSHA 300 and 300a Forms must be attached and are available through the OSHA publications search page.