ATTACHMENT 7 - Contractor Safety - Environmental Record Evaluation Form.docx

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Attached to
Z2DA--Correct Electrical Deficiencies Building 1D
Solicitation number
36E77620B0007
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This document includes a contractor safety and environmental record evaluation form along with details of a federal contract opportunity for corrective electrical work. The evaluation form requests information such as annual man hours, OSHA recordable incidents, injury rates, and any serious safety violations over the past three years to assess a contractor's safety performance.

The related federal contract opportunity is a solicitation to design and construct a new building to house relocated and new electrical equipment at the Reno VA Medical Center. The project involves general construction and mechanical and electrical work to remove an existing data closet and build a new one. The solicitation will be issued as an Invityation for Bid to SDVOSB contractors only with a NAICS code of 238210. The performance period is approximately 475 days with a contract value estimated between $2 million to $5 million. Questions must be submitted in writing by late August 2020 with award anticipated shortly thereafter.

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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36E77620B0007 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:

Category
2016
2017
2018
2019

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 .