ATTACHMENT 3 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Z1DZ--657-21-711JB EHRM Cerner Admin Space Construction Support - Jefferson Barracks Federal contract opportunity
- Solicitation number
- 36C77621B0012
About this file
This document contains a contractor safety and environmental record evaluation form and information on a federal contract solicitation. The evaluation form requests a contractor's OSHA 300 form information including man hours, cases involving days away from work or restricted activity, days away from work rate, and any serious OSHA violations over the past three years.
The solicitation is for design-bid-build construction support services for an EHRM Cerner admin space at the Jefferson Barracks VAMC in St. Louis, Missouri. The Department of Veterans Affairs Technology Acquisition Center Austin will issue the solicitation in early July 2021 under number 36C77621B0012 as a firm-fixed-price contract. All questions must be submitted in writing to the identified point of contact by the specified deadline.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C77621B0012 0005.docx | DOCX document | |
| 36C77621B0012 0004.docx | DOCX document | |
| 36C77621B0012 0003.docx | DOCX document | |
| 36C77621B0012 0002.docx | DOCX document | |
| 36C77621B0012 0001.docx | DOCX document | |
| Site Drawings.pdf | ||
| 36C77621B0012_1.docx | DOCX document | |
| ATTACHMENT 2 - Limitations on Subcontracting - Construction.docx | DOCX document | |
| ATTACHMENT 4 - DBA Wage Rates.pdf | ||
| ATTACHMENT 1 - Specifications Final 6-4-21.pdf |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621B0012 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 .