Attachment 07- Contractor Safety - Environmental Form.pdf

PDF 117 KB Posted

Attached to
Y1DA--EHRM Training and Admin Space Construction Support Muskogee Federal contract opportunity
Solicitation number
36C77623B0040
Issued by
Department of Veterans Affairs Technology Acquisition Center Austin

About this file

This document contains a Contractor Safety and Environmental Record Evaluation Form for solicitation number 36C77623B0040 for Y1DA--EHRM Training and Admin Space Construction Support Muskogee. The form requests contact information for the bidding company and utilization data from their OSHA 300 forms for the number of man hours, cases involving days away from work or restricted activity, days away restricted or transferred rate, and any serious, willful, or repeat OSHA violations from the past three years along with an explanation for any violations. Bidders are to provide safety and environmental record information on this form for consideration as part of the solicitation process.

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Other files for this federal contract opportunity

Other files attached to Y1DA--EHRM Training and Admin Space Construction Support Muskogee, newest first.
File Type Posted
Attachment 1-Technical Questions -Muskogee.docx DOCX document
36C77623B0040 0003.docx DOCX document
Attachment 2- VA Asbestos Abatement Manual.pdf PDF
36C77623B0040 0002.docx DOCX document
EHRM TASS Muskogee Site Visit Sign In.pdf PDF
Parking Plan 2023.pdf PDF
Site Visit Instructions - 2023 July 7-Revised.docx DOCX document
36C77623B0040 0001.docx DOCX document
Attachment 05- Site Visit Instructions.docx DOCX document
Attachment 03- Wage Determination Muskogee 6.20.pdf PDF
Attachment 01-Specifications - EHRM TASS-Muskogee.pdf PDF
36C77623B0040_1.docx DOCX document
Attachment 06- Site Map.pdf PDF
Attachment 04- Limitations on Subcontracting - Construction.docx DOCX document
Attachment 02- Drawings - EHRM TASS- Muskogee.pdf PDF
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Text version

Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36C77623B0040_1

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.

Contractor Safety and Environmental Record Evaluation Form

File details come from the government source that posted it. Updated .