Attachment 5 - Environmental Record Evaluation .docx
DOCX document 20 KB Posted
- Solicitation number
- 36C24724R0083
About this file
This document is a Contractor Safety and Environmental Record Evaluation Form related to Solicitation 36C24724R0083 for the project "Z1DA--PROJECT 544-21-119 INSTALL B10 PORCHES & CHARGING STATIONS" issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 7.
The form requires the contractor to provide information from their OSHA 300 forms, including the number of man-hours (jobsite and office), number of cases involving days away from work, restricted activity, or both, the days away, restricted, or transferred rate, and the number of serious, willful, or repeat OSHA violations within the last 3 years. The contractor must attach an explanation for any OSHA violations. This information will be used to evaluate the contractor's safety and environmental record as part of the solicitation process.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24724R0083 0003.docx | DOCX document | |
| PRICE SCHEDULE 02.docx | DOCX document | |
| 36C24724R0083 0002.docx | DOCX document | |
| Answers to RFIs as of - 25 July 2024.docx | DOCX document | |
| 36C24724R0083 0001.docx | DOCX document | |
| Attachment 7 - Two Story Porch Assembly Spec.pdf | ||
| Attachment 1 - STATEMENT OF WORK - SOW.docx | DOCX document | |
| Attachment 2 - DRAWINGS - Combined.pdf | ||
| Attachment 6 - Wage Determination .pdf | ||
| Attachment 3 - SPECIFICATIONS - 544-21-119.pdf | ||
| 36C24724R0083_1.docx | DOCX document | |
| Attachment 4 - Performance Relevancy Questions.pdf |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C24724R0083.
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2021 |
| 2022 |
| 2023 |
| 2024 |
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 .