ATTACHMENT 12 - Contractor Safety - Environmental Form.docx
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- Solicitation number
- 36C77622B0012
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract opportunity for construction services. The evaluation form requests information on a contractor's OSHA 300 forms including man hours, cases involving days away from work or restricted activity, days away from work rate, and any serious, willful, or repeat OSHA violations over the past three years.
The federal contract opportunity is solicitation number 36C77622B0012 from the Department of Veterans Affairs Technology Acquisition Center Austin for construction services at the Mather Medical Specialty Clinic. The project scope includes site preparation, demolition, foundations, superstructure, mechanical, electrical, plumbing, special systems, landscaping and other site improvements as required by the drawings and specifications for the new medical clinic to be built north of existing buildings 730 and 731 on a VA owned parcel.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0012 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 2019 |
| 2020 |
| 2021 |
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 .