Attachment 25 - Contractor Safety - Environmental Form.pdf
PDF 237 KB Posted
- Attached to
- Y1DZ--463-301 Construct Mental Health Building and Surface Parking Alaska (VA-22-00023262)
- Solicitation number
- 36C77622B0047
About this file
This document contains a contractor safety and environmental record evaluation form and information about a related federal contract opportunity. The evaluation form requests company information and safety data from 2018 to 2021, including man hours, OSHA recordable incidents, days away from work rates, and serious violations. Applicable bidders must attach explanations for any OSHA violations within the last three years.
The related federal contract opportunity is solicitation number 36C77622B0047 to construct a mental health building and surface parking area in Alaska for the Department of Veterans Affairs Technology Acquisition Center Austin. The opportunity type is a solicitation for a design-bid-build indefinite delivery/indefinite quantity fixed price construction contract. No further details are provided on response dates, award dates, pricing terms, set asides, or incumbent.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0047
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 .