Attachment 1- Contractor Safety - Environmental Form.docx
DOCX document 21 KB Posted
- Solicitation number
- 36C77623R0101
About this file
This is a contractor safety and environmental record evaluation form for solicitation 36C77622B0063. The form requests contact information and OSHA 300 data from contractors including man hours, cases involving days away from work or restricted activity, DART rates for 2019 through 2022, and any serious, willful, or repeat OSHA violations from the last three years along with explanations. Relatedly, solicitation 36C77623R0101 from the Department of Veterans Affairs Technology Acquisition Center Austin is for Y1DA--EHRM Infrastructure Upgrades Construction at Battle Creek, Michigan.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0063 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 .