Attachment 13 - Contractor Safety - Environmental Form.docx
DOCX document 27 KB Posted
- Solicitation number
- 36C77623B0046
About this file
This document is a contractor safety and environmental record evaluation form related to solicitation number 36C77623B0046 for the construction of Parking Garage 2 in Oklahoma City, Oklahoma. The form requests contact information for the contractor and utilization of OSHA 300 forms to provide safety metrics including number of man hours, number of injury cases involving days away from work or job restrictions, days away from work or job restriction rate, and any serious, willful, or repeat OSHA violations over the past three years along with explanations for any violations. The related federal contract opportunity is for the construction of Parking Garage 2 at the Oklahoma City VA Medical Center through solicitation 36C77623B0046 issued by the Department of Veterans Affairs Technology Acquisition Center in Austin, Texas.
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Parking Garage 2 Oklahoma City, OK | IFB# 36C77623B0046 Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77623B0046 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
| 2022 |
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 .