Atch 29 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1AZ--EHRM Infrastructure Upgrades Construction - Tomah Federal contract opportunity
- Solicitation number
- 36C77622B0031
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract opportunity for infrastructure upgrades at a Department of Veterans Affairs facility. The evaluation form requests a contractor's OSHA 300 form information for the past four years, including total man hours, days away from work cases, days away restricted or transferred rate, and any serious, willful, or repeat OSHA violations. The federal contract opportunity is for project number 36C77622B0031 to perform infrastructure upgrades and renovations at the Tomah VA facility in Wisconsin. Upgrades include electrical, HVAC, communication, security, fiber infrastructure, data center WAN, and hazardous material abatement. The response deadline and award date are not specified.
View the file
Other files for this federal contract opportunity
Show all 42
On GovTribe
Work with this file on GovTribe
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0031 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 .