36E77618R0079-013.docx

DOCX document 13 KB Posted

Attached to
Interventional Radiology Design-Build West Haven Federal contract opportunity
Solicitation number
36E77618R0079
Issued by
Department of Veterans Affairs Headquarters

About this file

From the source

36E77618R0079 ATTACHMENT 12 - CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD EVALUATION FORM.docx

View the file

Other files for this federal contract opportunity

Other files attached to Interventional Radiology Design-Build West Haven, newest first.
File Type Posted
36E77619C0025-000.docx DOCX document
36E77618R0079-0001007.docx DOCX document
36E77618R0079-0001006.docx DOCX document
36E77618R0079-002.doc DOC document
36E77618R0079-009.doc DOC document
36E77618R0079-008.docx DOCX document
36E77618R0079-011.docx DOCX document
36E77618R0079-005.docx DOCX document
36E77618R0079-014.pdf PDF
36E77618R0079-012.docx DOCX document
36E77618R0079-015.pdf PDF
36E77618R0079-006.docx DOCX document
36E77618R0079-007.doc DOC document
36E77618R0079-010.docx DOCX document
36E77618R0079-004.docx DOCX document
36E77618R0079-003.docx DOCX document
36E77618R0079-001.docx DOCX document
36E77618R0079-000.docx DOCX document
Show all 18

On GovTribe

Work with this file on GovTribe

  • Download the original file
  • Contacts named in this file
  • Similar government files
  • Ask GovTribe AI about this file
Try for free Login

Text version

The file's text, extracted by GovTribe without its formatting.

Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36E77618R0079 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:

Category
2015
2016
2017
2018

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.