Attachment 8 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1DA--EHRM Training and Admin Space Support Construction DBB Support Construction Minneapolis VAMC Federal contract opportunity
- Solicitation number
- 36C77622R0019
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract opportunity for construction services. The evaluation form requests information on a contractor's man-hours, OSHA recordable incidents, days away from work rates, and any serious, willful or repeat OSHA violations over the past three years.
The related federal contract opportunity is solicitation number 36C77622R0019 for EHRM training and administrative space support construction design-bid-build services at the Minneapolis VA Medical Center. The solicitation is for construction services and is being conducted by the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas. No further details on required services, pricing terms, response dates or awards are provided in this document.
View the file
Other files for this federal contract opportunity
Show all 23
On GovTribe
Work with this file on GovTribe
- 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 36C77622R0019 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 2019 |
| 2020 |
| 2021 |
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 .