Attachment 09 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1AZ--36C77621B0013 - Construct Administration Bldg. POD 1A (Minor) - Gainesville Federal contract opportunity
- Solicitation number
- 36C77621B0013
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal solicitation opportunity. The evaluation form requests information on a contractor's man hours, OSHA recordable incidents, days away from work rates, and any serious violations over the past three years.
The solicitation is for the construction of a new 26,000 square foot administration building at the Malcom Randall VA Medical Center in Gainesville, Florida. The single firm-fixed price contract will involve demolition, site work, utilities, and all aspects of construction as required by the contract drawings and specifications. The Department of Veterans Affairs Technology Acquisition Center Austin aims to award the contract for the design-bid-build project.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621B0013 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2017 |
| 2018 |
| 2019 |
| 2020 |
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 .