Attachment_13_-_Contractor_Safety_and_Environmental_Evaluation_Form.docx
DOCX document 13 KB Posted
- Solicitation number
- 36E77619R0013
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36E77619R0013 Attachment 13 - Contractor Safety and Environmental Evaluation Form.docx
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment_1_-_Statement_of_Work.docx | DOCX document | |
| Attachment_7_-_Schematic_Drawings.zip | ZIP file | |
| Attachment_11_-_SCA_Wage_Rates_-_Hennepin.pdf | ||
| Attachment_8_-_Siemens_Equipment_2-15-18.zip | ZIP file | |
| Attachment_6_-_Plumbing.zip | ZIP file | |
| Attachment_14_-_Brand_Name_J_A.pdf | ||
| Attachment_5_-_Original_Structural_Drawings.zip | ZIP file | |
| Attachment_10_-_Basement_Interstitial.zip | ZIP file | |
| 36E77619R0013_1.docx | DOCX document | |
| Attachment_3_-_1st_Floor_Drawings.zip | ZIP file | |
| Attachment_4_-_1st_Floor_Interstitial.zip | ZIP file | |
| Attachment_2_-_Specifications.zip | ZIP file | |
| Attachment_9_-_Minneapolis_VA_Revit_Standards.zip | ZIP file | |
| Attachment_12_-_Construction_Wage_Rates_-_Hennepin.pdf | ||
| 36E77619R0013-000.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 36E77619R0013 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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