36E77619R0086-020.docx
DOCX document Posted
- Attached to
- Replace Hemodialysis Unit Federal contract opportunity
- Solicitation number
- 36E77619R0086
About this file
36E77619R0086 Attachment 19 - Contractor Safety and Environmental Record Evaluation Form.docx
View the file
Other files for this federal contract opportunity
Show all 50
Replace Hemodialysis Unit has more files on GovTribe.
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
Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77619R0086 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 .