Attachment 7 - Contractor Safety and Environmental Record Evaluation Form.docx

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Attached to
Y1DA--Design and Construct Physical Therapy and Prosthetics Building (VA-20-00029522)
Solicitation number
36E77620R0030
Issued by

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This document contains a Contractor Safety and Environmental Record Evaluation Form and details of a federal contract opportunity for design and construction services. The Department of Veterans Affairs seeks to award a firm-fixed-price contract using design-build procedures for the design and construction of a physical therapy and prosthetics building at their Omaha VA Medical Center. Offerors must provide safety and environmental records from 2015 to 2018 using the OSHA 300 form, including man hours, injury cases, and DART and serious violation rates. The solicitation number is 36E77620R0030 and will be issued on or about July 10, 2020 as a total SDVOSB set-aside with an estimated value between $10-20 million and a period of performance of approximately 550 calendar days from notice to proceed.

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Other files

File Type Posted
S06 - Amendment 1 36E77620R0030 0001.docx DOCX document
Attachment 2 - 010000 General Requirements Final 05_14_2020.pdf PDF
Attachment 5 - VAMC Omaha PT and Prostetics_Simple CATEX_20200402 (002) (002).pdf PDF
S02 - Solicitation 36E77620R0030 FINAL.docx DOCX document
Attachment 3 - PT and Prosthetics Specs Final 03_09_2020.pdf PDF
Attachment 8 - Wage Determination Douglas County 6-5-2020.pdf PDF
Attachment 1 - SOW PT and Prosthetics Bridging Docs.pdf PDF
Attachment 9 - JA - Brand Name Items - PT and Prosthetics_Redacted.pdf PDF
Attachment 4 - ACC Geotechnical Report.pdf PDF
Attachment 6 - Past Performance Questionnaire.docx DOCX document
36E77620R0030_1.docx DOCX document
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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36E77620R0030 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 .