8 - Contractor Safety and Environmental Form.docx
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- Solicitation number
- 36C77622B0052
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract solicitation for construction services. The solicitation is for a general contractor to renovate the first floor of Building 24 at the Jefferson Barracks VA Medical Center in St. Louis, Missouri to provide training and administrative support space for employee health and wellness activation. The contractor will be responsible for demolishing existing structures, site preparation, and furnishing all labor, materials and equipment to complete the construction project. The evaluation form requests safety record information from contractors including man hours, OSHA reportable incidents, injury rates, and any serious violations over the past three years. The Department of Veterans Affairs Technology Acquisition Center in Austin, Texas is the contracting agency.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0052 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 2019 |
| 2020 |
| 2021 |
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 .