Attachment 4 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77623B0033
About this file
This form requests safety and environmental records from contractors for the solicitation numbered 36C77623B0033 to convert residential lots to paved parking for the Department of Veterans Affairs in Reno, Nevada. The form asks contractors to provide company information and OSHA 300 data including total man hours, cases involving days away from work or job transfer, days away from work rate, and any serious, willful, or repeat OSHA violations from the past three years along with explanations.
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Other files
| File | Type | Posted |
|---|---|---|
| Additional Technical Questions 2.docx | DOCX document | |
| 36C77623B0033 0002.docx | DOCX document | |
| Copy of Parking Lot Sign In.xlsx | XLSX spreadsheet | |
| 36C77623B0033 0001.docx | DOCX document | |
| S05 - Contractor Technical Questions - answers.pdf | ||
| Reno VAMC Asbestos Survey (Draft).pdf | ||
| Reno VAMC LBP Screening Report (Draft).pdf | ||
| Attachment 1 Statement of Work.pdf | ||
| Attachment 3 Site Visit.docx | DOCX document | |
| Attachment 2 Specifications Bid 20220429.pdf | ||
| 36C77623B0033_1.docx | DOCX document | |
| Attachment 9 - DBA Wage Rate.pdf | ||
| Attachment 5 LOCUST BID DOCUMENT 20220429.pdf | ||
| Attachment 7 TAYLOR BID DOCUMENT PART 1 20220429.pdf | ||
| Attachment 8 TAYLOR BID DOCUMENT PART 2 20220429.pdf | ||
| Attachment 6 WILSON BID DOCUMENT 20220429.pdf |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77623B0033 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 .