Attachment 8 - Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0021
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity to construct a fourth floor addition to the Audie L. Murphy VA Hospital in San Antonio, Texas. The evaluation form requests a contractor's OSHA 300 form information for the past four years, including man hours, cases involving days away from work or restricted activity, DART rates, and any serious, willful or repeat OSHA violations. The related federal contract opportunity, solicitation number 36C77622B0021, is to construct a fourth floor for the new 4G Cancer Center addition encompassing a chemotherapy treatment unit, pharmacy, apheresis clinic, medical-surgery clinic and administration offices. The contracting agency is the Department of Veterans Affairs Headquarters.
View the file
Other files
Show all 15
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0021 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2017 |
| 2018 |
| 2019 |
| 2020 |
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 .