About this file

This document is a Pre-Award Contractor Evaluation Form designed for bidders/offerors to complete and submit with a proposal. The form requires detailed safety and occupational health information, including OSHA-related metrics for the past four years. Specifically, contractors must provide data on:

  1. Number of man hours at job sites and offices
  2. Number of cases involving days away from work or restricted activity
  3. Days away/restricted transfer rates
  4. Number of serious, willful, or repeat OSHA violations within the last 3 years

Additional requirements include submitting the company's six-digit NAICS Code, identifying who administers the company's Safety and Health Program, and reporting the Insurance Experience Modification Rate (EMR). The form notes that an EMR greater than 1.0 will disqualify the contractor, and four serious, one repeat, or one willful violation will also result in disqualification. Contractors must attach copies of OSHA 300 and 300a forms as supporting documentation.

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Who administers your company’s Safety and Health Program?

Company’s Insurance Experience Modification Rate (EMR) for the past 3 years (an EMR of

File details come from the government source that posted it. Updated .