Attachment 3 - Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0016
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 a contractor's company information, man hours for 2016 through 2019, OSHA recordable incidents, days away from work or restricted activity rate, and details on any serious OSHA violations. The related federal contract opportunity is solicitation number 36C77622B0016 to construct consolidated clinic space for the Department of Veterans Affairs Technology Acquisition Center Austin. No other details are provided on required products or services.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77621R0014 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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 .