Attachment 17 - Rev Contractor Safety and Environmental Record Evaluation Form.docx
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- Solicitation number
- 36C77622R0061
About this file
This solicitation is for infrastructure upgrades to support Electronic Health Record Modernization at the VA Medical Campus in Leavenworth, Kansas. The scope of work includes replacing all telecommunications cabling in multiple buildings on campus with CAT6A copper and OM4 and OS2 optical fiber cabling. Additional capacity of 15% will be provided. New patch panels, racks, ladder racks, and patch cables will be installed in telecom rooms along with labeling in accordance with specifications. Wireless access point cabling will be replaced using purple jacketed cable. The project also involves adding new computer room air conditioning systems, electrical panels, backup generators, and a new 600 ton water cooled chiller to serve new telecom rooms.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622R0061 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 .