36E77619R0097-015.docx

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Attached to
Construct Clean Core (VA-19-00058573) Federal contract opportunity
Solicitation number
36E77619R0097
Issued by
Department of Veterans Affairs Headquarters

About this file

This document contains a contractor safety and environmental record evaluation form and information on a forthcoming federal contract solicitation. The evaluation form requests safety data from 2015 to 2018, including man hours, OSHA recordable incidents, days away from work rates, and serious violations. The related solicitation will be for construction services to build a clean core addition and renovate space at the Providence VA Medical Center in Rhode Island. The project involves constructing a new surgery suite within and adjacent to existing operating rooms, relocating certain areas, and adding an elevated clean core. The total project value is estimated between $5 million to $10 million. The solicitation will be a request for proposal conducted as a total small business set-aside for service-disabled veteran-owned small businesses. The contract period of performance is approximately 490 calendar days from notice to proceed. The pre-solicitation notice targets issuance on October 16, 2019.

36E77619R0097 Attachment 12 - Contractor Safety and Environmental Record Evaluation Form.docx

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Text version

Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36E77619R0097 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 .