ATTACHMENT 20 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0063
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract opportunity for an expansion construction project at a Department of Veterans Affairs medical center. The evaluation form requests safety-related information such as annual man hours, OSHA-reported injury cases, days away from work rates, and details of any serious violations over the past three years. The expansion construction project will reroute part of the road between the medical center and flood wall to allow for a two-story addition for a whole health clinic and mechanical space. The contract is available through the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0063 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 .