Attachment 15 CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD EVALUATION FORM.docx

DOCX document 13 KB Posted

Attached to
Y1DA--610A4-21-701 EHRM Infrastructure Upgrades Construction Ft. Wayne Federal contract opportunity
Solicitation number
36C77622B0028
Issued by
Department of Veterans Affairs Technology Acquisition Center Austin

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This document contains a Contractor Safety and Environmental Record Evaluation Form for solicitation 36C77622B0028 for EHRM Infrastructure Upgrades Construction at Fort Wayne. The form requests contact information and safety metrics from bidders including total man hours, OSHA recordable cases, DART rate, and any serious, willful, or repeat OSHA violations over the past three years along with explanations. Bidders are asked to provide their OSHA 300 forms and safety record details to be evaluated for the infrastructure construction work awarded by the Department of Veterans Affairs Technology Acquisition Center in Austin.

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Other files for this federal contract opportunity

Other files attached to Y1DA--610A4-21-701 EHRM Infrastructure Upgrades Construction Ft. Wayne, newest first.
File Type Posted
Attachment 2 EHRM ICRA Form - Ft. Wayne.pdf PDF
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36C77622B0028 0008.pdf PDF
36C77622B0028 0007.pdf PDF
0006 Attachment 1 Technical Question Responses.pdf PDF
36C77622B0028 0006.pdf PDF
36C77622B0028 0005.pdf PDF
36C77622B0028 0004.pdf PDF
36C77622B0028 0003.pdf PDF
36C77622B0028 0002.pdf PDF
36C77622B0028 0001.pdf PDF
Attachment 8 Drawing 08a_TELECOMMUNICATION.pdf PDF
Attachment 4 Drawing 04_ARCHITECTURAL_BID SET.pdf PDF
Attachment 1 Drawing 01_GENERAL_BID SET.pdf PDF
Attachment 12 610A4-21-701 Specifications Bound.pdf PDF
Attachment 3 Drawing 03_ENVIRONMENTAL.pdf PDF
Attachment 9 Drawing 08b_TELECOMMUNICATION.pdf PDF
Attachment 14 COVID-19 Safety Protocols 12-14-21.pdf PDF
36C77622B0028_1.docx DOCX document
Attachment 17 ELECTRICAL BID SET.pdf PDF
Attachment 16 Limitations on Subcontracting - Construction.docx DOCX document
Attachment 13 DBA Wage Determination - Ft Wayne 20220602.pdf PDF
Attachment 11 EHRM Ft Wayne Bid Documents Narrative.pdf PDF
Attachment 10 Drawing 09_SECURITY.pdf PDF
Attachment 7 Drawing 07_ELECTRICAL_BID SET.pdf PDF
Attachment 6 Drawing 06_MECHANICAL_BID SET.pdf PDF
Attachment 5 Drawing 05_FIRE PROTECTION_BID SET.pdf PDF
Attachment 2 Drawing 02_CIVIL_BID SET.pdf PDF
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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36E77620B0004 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 .