564-23-705_EXHIBIT B Contractor Evaluation Form.pdf
PDF 97 KB Posted
- Solicitation number
- 36C25625R0066
About this file
Exhibit B is a Contractor Evaluation Form for Construction Safety designed to assess a contractor's safety performance. The form requires detailed documentation of workplace safety metrics over three years (2022-2024), including man hours, OSHA recordable cases, Days Away, Restricted, or Transferred (DART) rate, and OSHA violations. Contractors must provide OSHA 300 and 300a Forms, identify who administers their Safety and Health Program, and disclose their current Insurance Experience Modification Rate (EMR).
The form mandates that if the EMR exceeds 1.0, the contractor must submit a written explanation from their insurance carrier detailing the reasons for the higher rate and providing an anticipated date when the EMR will be reduced to 1.0 or below. The documentation requirements are designed to comprehensively evaluate a contractor's safety performance and risk management practices, with all information to be obtained from official OSHA documentation and insurance carrier records.
View the file
Other files
Show all 13
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
FOR OFFICIAL USE ONLY
Exhibit B Contractor Evaluation Form
Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2022 2023 2024 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 explanations for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms.
These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
2. Who administers your company’s Safety and Health Program?
3. Company’s current Insurance Experience Modification Rate (EMR):
The above EMR rate must be obtained from offeror’s insurance carrier and furnished on insurance carrier’s letterhead. If EMR is greater than 1.0, attach a written explanation of the EMR from insurance carrier on insurance carrier’s letterhead describing the reasons for the EMR and the anticipated date the EMR may be reduced to 1.0 or below.
http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .