36E77619R0085-029.docx
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- Solicitation number
- 36E77619R0085
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This document contains a contractor safety evaluation form and information on a federal solicitation opportunity. The safety evaluation form requests contractor safety information such as number of man hours, OSHA recordable incidents, DART rates, and serious violations for the years 2016 through 2019.
The related federal solicitation is to investigate and correct water infiltration issues in buildings 5, 6, and 8 at the Dallas VA Medical Center. The project includes inspecting basements for water entry points, sealing penetrations, installing waterproofing, and remediating sheetrock and flooring damaged by mold. The solicitation will be a request for proposal evaluated under the lowest price technically acceptable process. It is set aside for SDVOSBs and will be issued on July 10, 2019 via Solicitation 36E77619R0085. The period of performance is 270 days and the construction magnitude is estimated between $1,000,000 to $2,000,000. Questions must be submitted in writing by the deadline to the issuing office.
36E77619R0085 Attachment 5 - Contractor Safety And Environmental Record Evaluation Form.docx
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77619R0085 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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 .