Attachment 13 - Contractor Safety - Env Rec Eval Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36E77620B0008_1
About this file
This document contains a contractor safety evaluation form and details of a federal contract solicitation. The solicitation is for the design and construction of an expansion to the Mental Health Clinic at the Southern Arizona VA Health Care System in Tucson, Arizona. Key details include that the solicitation number is 36E77620B0008_1, the project involves general construction work including demolition, site utilities, and architectural, structural, mechanical, plumbing and electrical systems. The solicitation will be issued in September or October 2020 as an Invitation for Bid conducted according to FAR Parts 14, 19 and 36. The award will be made to a Service-Disabled Veteran-Owned Small Business. The period of performance is approximately 600 calendar days from notice to proceed. The construction value is estimated between $2,000,000 and $5,000,000.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77620B0006 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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 .