Attachment 10 - Contractor Safety _ Env Record Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36E77620R0042
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract opportunity for retrofitting campus-wide infrastructure systems at a VA facility in White City, Oregon. 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 four years.
The federal contract opportunity is a competitive SDVOSB set-aside solicitation issued by the Department of Veterans Affairs. The contractor will provide all labor, project management, materials and equipment to complete retrofits to infrastructure systems at the White City VA Rehabilitation Center and Clinics according to drawings, specifications and statements of work in the solicitation package. The magnitude of construction is between $10-20 million and work must be done in accordance with the solicitation documents.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77620R0042 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 .