36E77618R0105-010.docx
DOCX document 13 KB Posted
- Attached to
- Upgrade Cath Lab 2 - Minneapolis Site Prep Federal contract opportunity
- Solicitation number
- 36E77618R0105
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36E77618R0105 ATTACHMENT 9 - CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD EVALUATION FORM.docx
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Other files for this federal contract opportunity
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|---|---|---|
| 36E77618C0040-000.docx | DOCX document | |
| 36E77618R0105-0004000.docx | DOCX document | |
| 36E77618R0105-0003000.docx | DOCX document | |
| 36E77618R0105-0003001.pdf | ||
| 36E77618R0105-0002000.docx | DOCX document | |
| 36E77618R0105-0002001.pdf | ||
| 36E77618R0105-0001002.zip | ZIP file | |
| 36E77618R0105-0001003.zip | ZIP file | |
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| 36E77618R0105-0001004.zip | ZIP file | |
| 36E77618R0105-0001001.pdf | ||
| 36E77618R0105-007.pdf | ||
| 36E77618R0105-003.pdf | ||
| 36E77618R0105-011.pdf | ||
| 36E77618R0105-008.docx | DOCX document | |
| 36E77618R0105-009.docx | DOCX document | |
| 36E77618R0105-002.pdf | ||
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| 36E77618R0105-001.docx | DOCX document | |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77618R0105 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.
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