ATTACHMENT 5 Contractor EMR Certification Form.docx
DOCX document 16 KB Posted
- Solicitation number
- 36C24926R0037
About this file
This is a Contractor Electronic Medical Records (EMR) Certification Form required for the Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Veterans Integrated Service Network 9 construction project to renovate Building 1 Primary Care (Solicitation 36C24926R0037).
The form is a certification template that contractors must complete to demonstrate their EMR system capabilities and compliance requirements for healthcare facility construction or renovation projects. As a template document, it establishes the framework for contractors to attest to their EMR system's compatibility, security standards, and integration capabilities with VA healthcare information systems. Contractors submitting proposals for this primary care facility renovation must certify their EMR systems meet VA specifications and federal healthcare IT security requirements, ensuring seamless interoperability with existing VA infrastructure upon project completion. The certification form serves as a mandatory compliance document rather than a specification of detailed technical requirements, functioning as a prerequisite for contract award consideration.
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Other files
| File | Type | Posted |
|---|---|---|
| ATTACHMENT 4 Calc. of Self Performed Work.xlsx | XLSX spreadsheet | |
| ATTACHMENT 2 Project Specifications Vol 2 of 2_614-17-113.pdf | ||
| ATTACHMENT 1 Project Specifications Vol 1 of 2_614-17-113.pdf | ||
| ATTACHMENT 9 DBA Wage Determination TN20260200 5-18-2026.pdf | ||
| ATTACHMENT 8 Past Performance Questionnaire_614-17-113.pdf.pdf | ||
| 36C24926R0037_1.docx | DOCX document | |
| ATTACHMENT 3 Project Drawings_614-17-113.pdf | ||
| ATTACHMENT 7 Price Breakout Schedule.xlsx | XLSX spreadsheet | |
| ATTACHMENT 6 General Conditions Breakout.xlsx | XLSX spreadsheet |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C24926R0037_1
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2023 |
| 2024 |
| 2025 |
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.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
2. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 236220
3. Who administers your company’s Safety and Health Program? ____________________________.
4. Company’s Insurance Experience Modification Rate (EMR): ____________________________
File details come from the government source that posted it. Updated .