ATTACHMENT 12 - Contractor Safety - Environmental Form.docx

This document contains a contractor safety and environmental record evaluation form and information on a federal contract solicitation to construct a dental clinic at the Bay Pines VA Medical Center. The evaluation form requests a contractor's OSHA 300 form information for the past four years, including total man hours, cases involving days away from work or job transfer, days away from work rate, and any serious, willful, or repeat OSHA violations in the past three years.

The solicitation is for general construction services to demolish an existing modular building and construct a new dental clinic, including mechanical, electrical, and plumbing work. The project also involves site utilities, a gravel parking lot, concrete walkways, select trees, and installation of a new generator and permeable pavement parking lot and driveway. The solicitation number is 36C77623B0029 and was issued by the Department of Veterans Affairs Technology Acquisition Center Austin for the Bay Pines VAMC.