Attachment 9 - Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1DZ-- Minor Construction - Tomah VAMC 676-233 Construct Material Shed Federal contract opportunity
- Solicitation number
- 36C77624B0014_1
About this file
This document is a Contractor Safety and Environmental Record Evaluation Form related to Solicitation 36C77624R0040. The form requires the contractor to provide information about their company's safety and environmental record, including the number of man hours, OSHA incidents, DART rate, and any OSHA violations within the last 3 years. The contractor must attach an explanation for any OSHA violations. This form is used to evaluate the contractor's safety and environmental performance as part of the evaluation criteria for the federal contract opportunity.
The related federal contract opportunity is Solicitation 36C77624B0014_1, a Minor Construction project to Construct a Material Shed in Tomah, WI for the Department of Veterans Affairs Technology Acquisition Center Austin.
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 36C77624R0040 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 .