Attachment 1 - EMR.pdf

This is an Experience Modification Rate Form that offerors must complete and return with their response to RFP No. 36C24726R0095.

The form requires offerors to provide company identification information including name, address, telephone, email, and primary contact. Offerors must complete a table documenting OSHA 300 Form data for calendar years 2023, 2024, and 2025, including: number of man hours worked at jobsites and offices; number of cases involving days away from work, restricted activity, or both; the Days Away, Restricted, or Transferred (DART) rate calculated as the number of such cases multiplied by 200,000 divided by man hours; and the number of serious, willful, or repeat OSHA violations within the past three years with attached explanations. Offerors must also provide copies of OSHA 300 and 300a Forms, which are accessible through the OSHA publications search page at http://www.osha.gov/pls/publications/publication.html. Additionally, offerors must disclose their company's Insurance Experience Modification Rate (EMR) for the past three years. The government will use the submitted information along with data from government systems, including OSHA and EPA online inspection history databases, to verify that the contractor meets the Experience Modification Rate requirements specified in the solicitation.