Att 4. Contractor Safety Environmental Form 635_423 Norman OK.docx
DOCX document 20 KB Posted
- Solicitation number
- 36C77623B0059
About this file
This document contains a contractor safety and environmental record evaluation form and information on a related federal contract opportunity. The evaluation form requests information from contractors such as number of man hours, OSHA recordable incidents, DART rates, and any serious, willful, or repeat OSHA violations from the past three years. Contractors are asked to provide this safety data for the years 2019 through 2022.
The related federal contract opportunity is solicitation number 36C77623B0059 for A/E design services for a specialty hospital located outside in Norman, Oklahoma. The solicitation was issued by the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77623B0059 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
| 2022 |
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 .