36E77620B0001-012.docx

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Attached to
Upgrade Switchgear and Distribution - Baltimore Federal contract opportunity
Solicitation number
36E77620B0001
Issued by
Department of Veterans Affairs Headquarters

About this file

This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity for upgrade switchgear and distribution work at a Veterans Affairs medical center. The contractor evaluation form requests safety data from 2016 to 2019 including man hours, OSHA recordable incidents, days away from work rates, and serious violations. The federal contract opportunity is a solicitation from the Department of Veterans Affairs to award a firm-fixed-price contract through an Invitation for Bid for upgrade work including construction of a new electrical room, installation of new switchgear and busway, HVAC and fire protection upgrades, and plumbing relocation. The project is expected to be between $5 million and $10 million with a 540 calendar day period of performance. The solicitation will be issued as a total Service-Disabled Veteran-Owned Small Business set-aside on or about January 8, 2020.

36E77620B0001 ATTACHMENT 5 - Contractor Safety - 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 36E77620B0001 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 .