Attachment_2_-_Contractor_Safety_and_Environmental_Record_Evaluation_Form.docx
DOCX document 13 KB Posted
- Solicitation number
- 36E77619R0008
About this file
This is a contractor safety and environmental record evaluation form related to solicitation number 36E77619R0008 for a new primary care clinic design-build minor at the Minneapolis VA Medical Center. The form requests a contractor to provide man hours, OSHA recordable incidents, DART rates, and any serious, willful, or repeat OSHA violations over the past four years in order to evaluate the contractor's safety and environmental record as part of the solicitation process for this opportunity with the Department of Veterans Affairs.
36E77619R0008 Attachment 2 - Contractor Safety and Environmental Record Evaluation Form.docx
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Other files
| File | Type | Posted |
|---|---|---|
| 36E77619R0008-0001000.docx | DOCX document | |
| 36E77619R0008-0001001.docx | DOCX document | |
| 36E77619R0008-0001001.docx | DOCX document | |
| 36E77619R0008-0001000.docx | DOCX document | |
| Attachment_7_-_Section_01_32_16_Project_Schedules.doc | DOC document | |
| 36E77619R0008_1.docx | DOCX document | |
| Attachment_12_-_Strucutral_Asbuilts.zip | ZIP file | |
| Attachment_3_-_Release_of_Claims.docx | DOCX document | |
| Attachment_13_-_Brand_Name_J_A.pdf | ||
| Attachment_11_-_Supporting_Data.zip | ZIP file | |
| Attachment_1_-_SOW_(1-7-2019).docx | DOCX document | |
| Attachment_6_-_SCA_Wage_Rates_-_Hennepin_-_12-26-18.pdf | ||
| Attachment_5_-_Construction_Wage_Rates_-_Hennepin_-_1-4-19.pdf | ||
| Attachment_4_-_Past_Performance_Questionnaire.docx | DOCX document | |
| Attachment_9_-__Minneapolis_VA_BIM_Management_Plan.zip | ZIP file | |
| Attachment_10_-_Minneapolis_VHA_Campus_Maps.zip | ZIP file | |
| Attachment_8_-_Specs.zip | ZIP file | |
| 36E77619R0008-000.docx | DOCX document | |
| 36E77619R0008-000.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 36E77619R0008 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. Updated .