36E77620R0031-A00002009.docx
DOCX document Posted
- Attached to
- Y1DA--SPECT/CT Site Preparation Project (Design-Build) Augusta, Georgia Charlie Norwood VAMC (Downtown)
- Solicitation number
- 36E77620R0031
About this file
This document contains a contractor safety evaluation form and information on a forthcoming federal contract solicitation. The safety evaluation form requests contractors to provide man-hour and injury data from their OSHA 300 forms for the past four years, as well as details on any serious OSHA violations.
The federal contract solicitation will be for design-build services to prepare a site for a SPECT/CT scanner at the Charlie Norwood VA Medical Center in Augusta, Georgia. The project involves remodeling an exam room and associated areas to accommodate a new scanner. The solicitation is expected to be released on March 20, 2020 as a total SDVOSB set-aside with a response period of approximately 180 days. The construction value is estimated between $500,000 and $1,000,000. Responses are due to the Department of Veterans Affairs via the specified contracting officer.
36E77620R0031 A00002 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 .