Attachment 2 - Contractor Safety - Environmental Form.docx
DOCX document 21 KB Posted
- Attached to
- Y1DA--757-22-705 EHRM Infrastructure Upgrades - Columbus, OH - Tier 2 Construction (VA-22-00108764)
- Solicitation number
- 36C77623R0150
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity. The evaluation form requests information on a contractor's number of man hours, OSHA-reported injury cases, days away from work rate, and any serious, willful, or repeat OSHA violations over the past four years. The related federal contract opportunity is solicitation number 36C77623R0150 from the Department of Veterans Affairs for EHRM infrastructure upgrades in Columbus, Ohio. The opportunity type is listed as a solicitation and appears to be for tier 2 construction services. No further details are provided on required scope, response deadline, or award information.
View the file
Other files
Show all 44
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 36C77623R0150-1 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 .