Contractor Safety and Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1DZ--657-21-702JC EHRM Training and Admin Space Construction - St Louis VAMC - John Cochran
- Solicitation number
- 36C77622B0056
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity. The evaluation form requests information from contractors such as number of man hours, OSHA recordable cases, days away from work rates, and serious violations over the past three years.
The related federal contract opportunity is solicitation number 36C77622B0056 for construction of training and administrative support space at the St. Louis VA Medical Center. The project involves construction services under an invitation for bid. The contracting agency is the Department of Veterans Affairs Technology Acquisition Center located in Austin. Relevant details include the solicitation and project names, opportunity type as an invitation for bid, a brief description of required construction services, and the involved federal agency.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0056 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 2019 |
| 2020 |
| 2021 |
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.
File details come from the government source that posted it. Updated .