36E77620R0031-009.docx

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Y1DA--SPECT/CT Site Preparation Project (Design-Build) Augusta, Georgia Charlie Norwood VAMC (Downtown)
Solicitation number
36E77620R0031
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This document contains a contractor safety evaluation form and information on a federal contract opportunity for a SPECT/CT site preparation project. The safety evaluation form requests contractors provide man-hour and injury data from OSHA 300 forms for 2015 through 2018, as well as details on any serious OSHA violations in the last three years. The federal contract opportunity is a design-build project issued by the Department of Veterans Affairs to prepare exam room space for a new medical imaging device at the Charlie Norwood VA Medical Center in Augusta, Georgia. The project scope includes demolition, framing, electrical, HVAC, insulation, wall finishing, doors and windows. The solicitation will be a total SDVOSB set-aside issued on or around March 20, 2020 as an RFP, with a performance period of approximately 180 days and estimated value between $500,000 and $1 million. Questions must be submitted in writing by the specified deadline.

36E77620R0031 S02 - Attachment 8 - 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 36E77618R0092 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 .