Attachment 23 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1BG--EHRM Infrastructure Upgrades Design Build - Reno Federal contract opportunity
- Solicitation number
- 36C77621R0117
About this file
This document contains a contractor safety and environmental record evaluation form and information on a related federal contract opportunity for infrastructure upgrades at a Department of Veterans Affairs facility. The evaluation form requests a contractor's OSHA 300 form information for the past four years, including total man hours, cases involving days away from work or job transfer, days away from work rate, and any serious OSHA violations in the past three years.
The related federal contract opportunity, solicitation number 36C77621R0117, is for a design-build project to relocate or remodel approximately 28 telecommunications rooms and one data center at a Veterans Affairs facility in Reno, Nevada. The contractor shall provide all labor, materials, tools, and services necessary to complete the project in accordance with VA and facility IT infrastructure standards while maintaining ongoing IT services.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621R0117 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 .