Attachment 4 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77623B0007
About this file
This form requests safety and environmental records from contractors. It asks for the company name, address, phone numbers, email, and contact. It then requests annual numbers of man hours, OSHA-recordable injuries, days away from work cases, and DART rates from 2018 to 2021. Contractors must also attach explanations for any serious, willful, or repeat OSHA violations in the last three years.
The related federal contract opportunity is solicitation number 36C77623B0007 to correct roofing deficiencies at building 700 at the Mather campus of the Veterans Affairs Technology Acquisition Center Austin. No other details are provided on the required products or services.
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Other files
| File | Type | Posted |
|---|---|---|
| 075416 VA Spec for KEE Roofing V2.pdf | ||
| 36C77623B0007 0004.docx | DOCX document | |
| 36C77623B0007 0003.docx | DOCX document | |
| 075416 VA Spec for KEE Roofing.pdf | ||
| Possible Crane Lift Areas and Laydown Area.pdf | ||
| 36C77623B0007 0002.docx | DOCX document | |
| B700 Roof Drawings As Built.pdf | ||
| Attachment 9 - B700 Roof Photos.pdf | ||
| Attachment 10 - B700 Roof Drawings.pdf | ||
| 36C77623B0007 0001.docx | DOCX document | |
| Attachment 1 - CONSTRUCTION SOW - BLDG 700 Roofing.docx | DOCX document | |
| Attachment 5 - COVID-19 Safety Protocols 12-14-21.pdf | ||
| Attachment 6 - DBA Wage Rate - San Francisco County 1.20.23.pdf | ||
| Attachment 2 - Specifications.zip | ZIP file | |
| Attachment 8 - Release of Claims.docx | DOCX document | |
| Attachment 3 - Site Visit Memo Mather.docx | DOCX document | |
| 36C77623B0007.docx | DOCX document | |
| Attachment 7 - Limitations on Subcontracting - Construction.docx | DOCX document |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77623B0007 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 .