Attachment 44 - Contractor Safety - Environmental Form.docx

DOCX document 14 KB Posted

Attached to
Y1DA--EHRM Infrastructure Upgrades Construction Jefferson Barracks
Solicitation number
36C77623R0009
Issued by

About this file

This document contains a contractor safety and environmental record evaluation form and details of a federal contract opportunity for infrastructure upgrades at the St. Louis Jefferson Barracks VAMC. The evaluation form requests information on a contractor's man hours, OSHA recordable incidents, DART rates, and any serious, willful, or repeat OSHA violations over the past four years. The federal contract opportunity, solicitation number 36C77623R0009, is seeking a general contractor to provide electrical, HVAC, data center, communication, security, and fiber infrastructure upgrades across multiple buildings at the VA medical center campus. The scope of work involves upgrades to electrical panels, power systems, building management systems, data and communication outlets, exterior and interior walls, and hazardous material abatement. The contracting agency is the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas.

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Text version

Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36C77623R0009 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:

Category
2019
2020
2021
2022

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 .