Attachment 08 - Contractor Safety and Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Z1DA--554-21-700 - EHRM Infrastructure Upgrades (Const) Denver, CO (PCAC) (VA-22-00042625)
- Solicitation number
- 36C77622B0051
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 a contractor provide man-hour data from their OSHA 300 forms for 2018 through 2021, as well as details on cases involving days away from work or restricted activity. It also asks for the contractor's days away, restricted, or transferred rate and any serious, willful, or repeat OSHA violations over the last three years.
The related federal contract opportunity is solicitation number 36C77622B0051 for EHRM infrastructure upgrades construction at the Denver VA Medical Center. The solicitation seeks offers for construction services to upgrade electrical, HVAC, and other building systems. The solicitation is available through the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas, with proposals due on an unspecified date.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0051 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 .