EXHIBIT A CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY.pdf
PDF 57 KB Posted
- Attached to
- Resolving Plumbing Issues Federal contract opportunity
- Solicitation number
- 36C25620R0125
About this file
This document contains an evaluation form for contractor safety and a related federal contract opportunity notice for plumbing services. The evaluation form requests safety-related information from contractors such as OSHA recordable incident rates, numbers of violations, and insurance experience modification rates. It also asks who administers the contractor's safety program. The related federal contract opportunity is from the Department of Veterans Affairs to provide design/build services for new and revised site utilities and plumbing repairs at facilities in Southeast Louisiana. The contractor must provide all labor, equipment, and resources for this project.
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Text version
Exhibit A Contractor Evaluation Form
Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2017 2018 2019
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 will lower technical rating of offeror significantly.)
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 current insurance Experience Modification Rate (EMR):___________________ http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .