Atch 42 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1AZ--EHRM Infrastructure Upgrades Construction - St. Cloud Federal contract opportunity
- Solicitation number
- 36C77622B0035
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract solicitation for infrastructure upgrades at a Veterans Affairs health care facility. The evaluation form requests information such as the number of man hours, OSHA-recordable cases, days away from work rates, and serious violations over the past three years to assess contractor safety performance. The related solicitation, number 36C77622B0035, is for electrical, HVAC, data center, fiber infrastructure, and hazardous materials abatement work at the St. Cloud VAHCS. The contractor shall furnish all labor, materials, tools, and equipment to complete the infrastructure improvements according to specifications and drawings. The awarding agency is the Department of Veterans Affairs Technology Acquisition Center located in Austin.
View the file
Other files for this federal contract opportunity
Show all 50
Y1AZ--EHRM Infrastructure Upgrades Construction - St. Cloud has more files on GovTribe.
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 36C77622B0035 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 .