ATTACHMENT 4 - EMR.pdf

This is a Pre-Award Contractor Evaluation Form (EMR Form) that bidders and offerors must complete and submit with their proposals to federal contracting opportunities.

The form requires contractors to provide company identification information including name, address, telephone, fax, email, and primary contact. Contractors must complete OSHA 300 Form data for four calendar years (2022-2025) documenting: total man hours worked at jobsites and offices; number of cases involving days away from work, restricted activity, or both; days away/restricted/transferred rate (DART Rate) calculated as the number of cases multiplied by 200,000 divided by total man hours; and the number of serious, willful, or repeat violations issued by OSHA within the past three years. An EMR greater than 1.0 disqualifies the contractor. Additionally, contractors must provide their six-digit North American Industrial Classification System (NAICS) Code, identify who administers the company's Safety and Health Program, and submit copies of OSHA 300 and 300a Forms with the proposal. This form serves as a safety and health compliance screening tool used by federal agencies during the pre-award evaluation process to assess contractor safety performance and eligibility.