Attachment 10 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1DA--EHRM Training and Admin Phase II - Poplar Bluff Federal contract opportunity
- Solicitation number
- 36C77623B0028
About this file
This document contains a contractor safety and environmental record evaluation form for solicitation 36C77623B0010 from the Department of Veterans Affairs Technology Acquisition Center Austin. The form requests contact information for the bidding company and OSHA 300 data including man hours, cases involving days away from work or restricted activity, days away restricted or transferred rate, and any serious, willful, or repeat OSHA violations from the past three years along with explanations. The related federal contract opportunity is for solicitation 36C77623B0028 for EHRM training and administration phase II services in Poplar Bluff.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77623B0010 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 .