Attachment 4 CONTRACTOR SAFETY AND ENVIRONMENTAL RECORD EVALUATION FORM.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0005
About this file
This document contains a Contractor Safety and Environmental Record Evaluation Form to be completed by bidders for Solicitation 36C77622B0005. The form requests information on man hours, OSHA recordable cases, days away/restricted/transferred rate, and serious/willful/repeat OSHA violations for years 2017 through 2020. Bidders must attach an explanation for any OSHA violations in the last three years.
The related solicitation is for the Department of Veterans Affairs to award a firm-fixed-price contract for re-cabling the data center at the Durham VA Medical Center in Durham, North Carolina. Responses are due under Solicitation 36C77622B0005 for design-bid-build services at the specified location.
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Other files
| File | Type | Posted |
|---|---|---|
| Attachment IFB Microsoft Teams Meeting Information.docx | DOCX document | |
| Attachment THERMAL AND MOISTURE PROTECTION.pdf | ||
| 36C77622B0005 0004.docx | DOCX document | |
| Attachment 2 190378_VA Durham_Comprehensive Drawings Set Updated.pdf | ||
| 36C77622B0005 0003.docx | DOCX document | |
| Attachment Technical Questions.docx | DOCX document | |
| Attachment VHA Supplemental Contract Requirements for Combatting COVID-19 Updated 12-14-2021.docx | DOCX document | |
| 36C77622B0005 0002.docx | DOCX document | |
| 36C77622B0005 0001.docx | DOCX document | |
| Attachment Site Visit Sign in Sheet.pdf | ||
| Attachment 1 190378_VA Durham_ComprehensiveSpecifications.pdf | ||
| Attachment 2 190378_VA Durham_Comprehensive Drawings Set.pdf | ||
| 36C77622B0005.docx | DOCX document | |
| Attachment 3 Wage Determination DBA 11.1.pdf |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0005 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 .