Att 10 - Contractor Safety - Enviro Record Eval Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0025
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity for infrastructure upgrades at the Tomah VA Medical Center. The evaluation form requests information on a contractor's man hours, OSHA recordable incidents, days away from work rates, and serious violations over the past four years to evaluate the contractor's safety and environmental record for Solicitation 36C77622B0025. The federal contract opportunity seeks a general contractor to expand an existing building by approximately 5,000 square feet to incorporate a new data center and correct accessibility and computer room deficiencies. The awarded firm will furnish all labor, materials, equipment, and supervision to complete the infrastructure upgrades at the Tomah VAMC under the oversight of the Department of Veterans Affairs Technology Acquisition Center in Austin.
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Contractor Safety and Environmental Record Evaluation Form
The information provided below is current and applicable to Solicitation 36C77622B0025 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 .