Attachment - Contractor Safety - Environmental Form.docx
DOCX document 20 KB Posted
- Solicitation number
- 36C77623R0103
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' OSHA 300 forms including man hours, cases involving days away from work or restricted activity, days away restricted or transferred rate, and any serious, willful, or repeat OSHA violations from the past three years.
The related federal contract opportunity is solicitation number 36C77623R0103 to construct additions and renovations for a primary joint ambulatory care clinic in Pensacola, Florida. The solicitation is issued by the Department of Veterans Affairs Technology Acquisition Center located in Austin. No further details are provided regarding response dates, pricing terms, set asides, or incumbent contractors.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77623R0103 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2020 |
| 2021 |
| 2022 |
| 2023 |
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 .