Attachment 9 - Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622R0121
About this file
This document contains a Contractor Safety and Environmental Record Evaluation Form to be completed by bidders for solicitation 36C77622R0121 from the Department of Veterans Affairs. The form requests information on man hours, OSHA recordable incidents, days away from work rates, and serious violations for the years 2019 through 2022. Bidders must provide details of any OSHA violations from the past three years. The related opportunity is for construction of a parking garage in West Haven, Connecticut on a design-bid-build basis.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622R0121 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 .