Attachment 13 - CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD EVALUATION FORM.docx
DOCX document 13 KB Posted
- Solicitation number
- 36C77621B0003
About this file
This document contains a Contractor Safety and Environmental Record Evaluation Form and details of a federal contract opportunity for an Emergency Department expansion project at the Cleveland VA Medical Center.
The Evaluation Form requests safety and environmental record information from prospective contractors, including man hours, OSHA-reported injury cases, days away/restricted duty rates, and serious violations over the past three years. The federal contract opportunity is a solicitation for a single firm-fixed-price Design-Bid-Build contract issued by the VA. The project scope involves a 27,000 square foot, two-story addition and 10,000 square foot renovation to expand the Emergency Department and add Mental Health and Specialty Care clinics at the Cleveland VAMC. The estimated period of performance is 695 calendar days. The solicitation will be set aside for Service-Disabled Veteran-Owned Small Businesses and issued on February 26, 2021.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621B0003 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 .