Atch 28 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1AZ--EHRM Infrastructure Upgrades Construction - Marion Federal contract opportunity
- Solicitation number
- 36C77622B0040
About this file
This document contains a contractor safety and environmental record evaluation form and information on a related federal contract opportunity for infrastructure upgrades at a Department of Veterans Affairs facility. The evaluation form requests a contractor's OSHA 300 forms and related safety data for the past four years, including total man hours, days away from work cases, days away from work rate, and any serious OSHA violations. The federal contract opportunity is for infrastructure upgrades and renovations at a VA facility in Marion, involving electrical, HVAC, communication, security, and fiber upgrades across buildings as well as data center and hazardous material abatement work. The solicitation number is 36C77622B0040 and was issued by the VA Technology Acquisition Center in Austin.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0040 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 .