ATTACHMENT 7 - EMR.pdf

This is a Pre-Award Contractor Evaluation Form (EMR Form) that bidders and offerors must complete and submit with their proposals for federal contract opportunities.

The form requires contractors to provide company identifying information including name, address, telephone, fax, email, and primary contact. Contractors must complete OSHA 300 Form data for four calendar years (2022-2025), documenting the number of man hours worked at jobsites and offices, the number of cases involving days away from work or restricted activity, the days away/restricted/transferred rate (DART Rate) calculated as the number of applicable cases multiplied by 200,000 divided by total man hours, and any serious, willful, or repeat violations from OSHA within the past three years with required explanations. Additionally, contractors must provide their six-digit North American Industrial Classification System (NAICS) code for the acquisition, identify who administers their company's Safety and Health Program, and report their Insurance Experience Modification Rate (EMR) for the past three years. A disqualifying threshold is established: contractors with four serious violations, one repeat violation, or one willful violation from OSHA, or those with an EMR greater than 1.0, are disqualified from consideration. Copies of OSHA 300 and 300a Forms must be attached and are available through the OSHA publications search page.