EMR 1 page.docx

This is a Pre-Award Contractor Safety and Environmental Record Form designed to assess contractor qualifications regarding workplace safety and environmental compliance for federal procurement purposes. The form requires contractors to submit comprehensive safety data for the years 2023 through 2026, including total man hours worked, the number of cases involving days away from work or restricted activity, and the Days Away, Restricted, or Transferred (DART) rate calculated using OSHA's standard formula of cases multiplied by 200,000 divided by total man hours. Contractors must also disclose any serious, willful, repeat violations from OSHA or EPA violations within the past three years with detailed explanations, and provide copies of OSHA 300 and 300a forms accessible through the OSHA publications search page. Additionally, the form requires identification of the individual administering the company's Safety and Health Program.

The form mandates submission of the company's Insurance Experience Modification Rate (EMR) for the past three years, with a requirement that the EMR must be 1.0 or lower to meet pre-award qualifications. Contractors must complete all sections with company name, address, telephone, fax, email, and primary contact information. This form serves as a critical screening mechanism for the Department of Veterans Affairs procurement process to ensure that contractors meet baseline safety and environmental standards before contract award, thereby reducing risk and promoting workplace safety compliance on federal projects.