0006 Attachment 6 - Attachment 9 - Contractor Safety and Environmental Record Eval Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622R0121
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity for construction of a parking garage in West Haven, Connecticut. The evaluation form requests safety-related information from 2019 to the present, including total man hours, OSHA-recordable incidents, days away from work rates, and any serious violations. The related solicitation is for design-bid-build construction of a parking garage through the Department of Veterans Affairs, solicitation number 36C77622R0121, with responses due on January 21, 2022. Interested contractors are required to submit safety records utilizing the provided evaluation form to be considered for the award.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
| 2022 |
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 .