Attachment 8 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1DA--EHRM Training and Admin Space Support Construction - Kansas City VAMC Federal contract opportunity
- Solicitation number
- 36C77623B0020
About this file
This document is a contractor safety and environmental record evaluation form related to solicitation 36C77623B0020 for EHRM Infrastructure Upgrades at the Kansas City Veterans Affairs Medical Center. The form requests a contractor's OSHA 300 data from 2019 through 2022 including total man hours, number of cases involving days away from work or job transfer, and days away from work rate. It also asks for any serious, willful, or repeat OSHA violations in the last three years along with an explanation for any violations. The solicitation is for Y1DA--EHRM Training and Admin Space Support Construction services and is issued by the Department of Veterans Affairs Technology Acquisition Center Austin.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77623B0020 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2019 |
| 2020 |
| 2021 |
| 2022 |
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 .