ATTACHMENT 10 Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36E77620R0048
About this file
This document contains a solicitation for site support services for a Chest X-Ray system renovation project. The Department of Veterans Affairs intends to solicit bids and award a firm-fixed-price contract using design-build procedures for the design and construction of a Chest X-Ray system at the Bronx VA Medical Center. The project scope includes replacing an existing Chest X-Ray system with a new model and associated utilities, and potentially modifying examination and control rooms. The solicitation will be a Request for Proposal issued on or around September 15th, 2020 to Service-Disabled Veteran-Owned Small Businesses only, with a period of performance of approximately 240 calendar days. The magnitude of construction is estimated between $500,000 and $1 million. All questions must be submitted in writing by the specified date.
View the file
Other files
Show all 18
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77620R0047 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2015 |
| 2016 |
| 2017 |
| 2018 |
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 .