EMR 1 page.docx
DOCX document 19 KB Posted
- Solicitation number
- 36C24827Q0004
About this file
This file is a Pre-Award Contractor Safety and Environmental Record Form that collects historical safety and compliance data from contractors bidding on federal construction projects.
The form requires contractors to provide detailed occupational safety and health information for the past four years (2023-2026), including total man-hours worked, OSHA 300 form data documenting cases involving days away from work or restricted activity, and calculated DART (Days Away, Restricted, or Transferred) rates. Contractors must also disclose any serious, willful, repeat, or EPA violations incurred within the last three years and provide supporting documentation. Additionally, the form requires identification of the individual administering the company's Safety and Health Program and submission of the company's Insurance Experience Modification Rate (EMR) for the past three years, with a mandatory requirement that the EMR not exceed 1.0. Contractors must attach copies of OSHA 300 and 300A forms (accessible through OSHA's publications search page) along with explanations for any reported violations. This pre-award requirement applies to the Bay Pines VAMC steam piping repair project (Solicitation Number 36C24827Q0004), a Veterans Affairs procurement set-aside exclusively for Service-Disabled Veteran-Owned Small Businesses (SDVOSB) certified through VetCert, with an RFP anticipated August 5, 2026. Interested contractors must be actively registered in the Small Business Search database and SAM.gov at the time of quote submission.
View the file
Other files
| File | Type | Posted |
|---|---|---|
| PPQ.pdf | ||
| SHOP DRAWINGS HIGH PRESSURE STEAM PUMPED ROVANCO PIPING SYSTEM.pdf | ||
| Base Offer Price Breakdown - 1 page.xlsx | XLSX spreadsheet | |
| 516-26-117 Specifications 00 01 10.pdf | ||
| 05_SOW 516-26-117.pdf | ||
| WD-FL20260222 DATED 5-18-26.pdf | ||
| 36C24827Q0004_1.pdf | ||
| 05_Drawings SECTION LP302- 516-26-117.pdf | ||
| SHOP DRAWINGS HIGH PRESSURE STEAM PUMPED ROVANCO PIPING SYSTEM.pdf | ||
| WD-FL20260222 DATED 5-18-26.pdf | ||
| 05_Drawings SECTION LP302- 516-26-117.pdf | ||
| ASBUILTS-516-26-117.pdf | ||
| PPQ -Request form.docx | DOCX document | |
| PPQ.pdf | ||
| Base Offer Price Breakdown - 1 page.xlsx | XLSX spreadsheet | |
| 05_ASBUILTS-516-26-117.pdf | ||
| 36C24827Q0004_1.pdf | ||
| 516-26-117 Specifications 00 01 10.pdf | ||
| EMR 1 page.docx | DOCX document | |
| SHOP DRAWINGS HIGH PRESSURE STEAM PUMPED CONDENSATE ROVANCO PIPING SYSTEM.pdf | ||
| 05_Drawings LP302- 516-26-117.pdf | ||
| 36C24827Q0004.docx | DOCX document |
Show all 22
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Text version
Attachment Safety or Environmental Violations and Experience Modification Rate
Pre-Award Contractor Safety and Environmental Record Form Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2023 |
| 2024 |
| 2025 |
| 2026 |
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 or any EPA violations within the last 3 years. Please attach explanation for any violations.
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. Who administers your company’s Safety and Health Program?
3. Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of 1 or less is required):
File details come from the government source that posted it. Updated .