ATTACHMENT 17 - Contractor Safety - Environmental Form.docx

DOCX document 14 KB Posted

Attached to
Y1DZ--Construct CLC Cottage (Minor) - Sioux Falls Federal contract opportunity
Solicitation number
36C77621B0016
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 and information on a related federal contract opportunity to construct a new hospice cottage at the Sioux Falls VA Medical Center. The evaluation form requests a contractor's OSHA 300 form information for the past four years, including total man hours, days away from work cases, days away from work rate, and any serious OSHA violations. The related federal contract opportunity, solicitation number 36C77621B0016, is to furnish all labor and materials to build an 11,115 square foot hospice cottage in accordance with the attached drawings and specifications. The contracting agency is the Department of Veterans Affairs Technology Acquisition Center located in Austin.

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Other files for this federal contract opportunity

Other files attached to Y1DZ--Construct CLC Cottage (Minor) - Sioux Falls, newest first.
File Type Posted
Technical Questions - FINAL - Sioux Falls 9-15-21.pdf PDF
Geotechnical Report - 9-1-2016.pdf PDF
36C77621B0016 0002.pdf PDF
ATTACHMENT 14 - Construction Wage Rates - Minnehaha County 9-3-21.pdf PDF
Site Visit Sign-in Sheet 8-31-21.pdf PDF
36C77621B0016 0001.pdf PDF
ATTACHMENT 11 - Asbestos Report Bldg. 1.zip ZIP file
ATTACHMENT 12 - Contractor Core Work Hours.pdf PDF
ATTACHMENT 18 - Site Visit - Map.pdf PDF
ATTACHMENT 2 - Specifications Volume 2.pdf PDF
ATTACHMENT 7 - Drawings 3 of 6 - Architectural.pdf PDF
ATTACHMENT 9 - Drawings 5 of 6 - Mechanical.pdf PDF
ATTACHMENT 13 - Brand Name Justification - Sioux Falls.pdf PDF
ATTACHMENT 14 - Construction Wage Rates - Minnehaha County 8-13-21.pdf PDF
ATTACHMENT 16 - AUSH Visitation Memo - FINAL August 2021.pdf PDF
ATTACHMENT 1 - Specification Volume 1.pdf PDF
ATTACHMENT 4 - Specifications Volume 4.pdf PDF
ATTACHMENT 5 - Drawings 1 of 6 - Code.pdf PDF
ATTACHMENT 6 - Drawings 2 of 6 - Civil-Landscaping.pdf PDF
ATTACHMENT 8 - Drawings 4 of 6 - Structural.pdf PDF
36C77621B0016 - 8-19-21.pdf PDF
ATTACHMENT 3 - Specifications Volume 3.pdf PDF
ATTACHMENT 10 - Drawings 6 of 6 - Electrical.pdf PDF
ATTACHMENT 15 - Limitations on Subcontracting - Construction.docx DOCX document
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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36C77621B0016 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 .