Attachment 13 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0036
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract solicitation. The evaluation form requests information on a contractor's man hours, OSHA recordable incidents, days away from work rates, and any serious violations over the past three years.
The related federal contract solicitation is for renovating electrical and telecom closets at the 109 Bee Street location of the Charleston VA Medical Center. The solicitation provides the project address and description, and indicates it is being issued by the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas. Details on response due dates or contract award timing are not included.
View the file
Other files
Show all 24
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0018 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 .