ATTACHMENT 9 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77621B0004
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract opportunity for the expansion of surgical services at the Oklahoma City VA Medical Center.
The evaluation form requests a contractor provide man-hours, OSHA recordable incidents, days away from work rates, and details of any serious OSHA violations over the past three years. The federal contract opportunity is a solicitation from the Department of Veterans Affairs to award a firm-fixed-price contract for a two-phase expansion of the surgical services unit and locker room. Phase one involves building an upgraded surgery locker and elevator extension, while phase two renovates the surgical services area upon completion of phase one. The solicitation number is 36C77621B0004 and is for construction services at the Oklahoma City VA Medical Center located at 921 NE 13th Street in Oklahoma City, Oklahoma.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621B0004 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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 .