Attachment 10 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0022
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity for replacing mechanical systems at the Fresno Veterans Affairs Medical Center. The evaluation form requests a contractor's OSHA 300 form information over multiple years, including man hours, cases involving days away from work or restricted activity, DART rates, and any serious, willful, or repeat OSHA violations. The related solicitation is for providing all tools, equipment, materials, labor and construction services to replace mechanical systems at the Fresno VAMC in accordance with attached specifications and drawings. The solicitation number is 36C77622B0022 and is being conducted by the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0022 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 .