ATTACHMENT 9 - Contractor Safety - Environmental Form.docx

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Y1AZ--EHRM Training and Administrative Support Space Construction - Tomah Federal contract opportunity
Solicitation number
36C77622B0010
Issued by
Department of Veterans Affairs Technology Acquisition Center Austin

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This form requests safety and environmental records from contractors interested in the solicitation for renovating training and administrative spaces at the Tomah VA Medical Center in Wisconsin. It asks for annual numbers of man-hours worked, OSHA-recordable injuries, days away from work due to injuries, and serious violations over the past three years. Contractors must explain any violations reported. The solicitation seeks a general contractor to renovate exam rooms, offices, and permanently mounted equipment for approximately $5 million. Bids are due by January 2023 and work must be complete by 2024. Relevant experience, safety history, and compliance will be evaluated in selecting a contractor for this project with the Department of Veterans Affairs.

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ATTACHMENT 8 - Construction Wage Rates - Monroe County - 2-4-22.pdf PDF
36C77622B0010 0002.pdf PDF
ATTACHMENT 8 - Construction Wage Rates - Monroe County - 1-7-22.pdf PDF
36C77622B0010 0001.pdf PDF
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ATTACHMENT 7 - Limitations on Subcontracting - Construction.docx DOCX document
36C77622B0010 - 12-27-21.pdf PDF
ATTACHMENT 5 - Contractor Core Work Hours.pdf PDF
ATTACHMENT 6 - COVID-19 Safety Protocols 12-14-21.pdf PDF
ATTACHMENT 8 - Construction Wage Rates - Monroe County - 12-17-21.pdf PDF
ATTACHMENT 1 - Specifications - Vol 1 of 2.pdf PDF
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ATTACHMENT 4 - Brand Name Justification - Tomah.pdf PDF
ATTACHMENT 3 - Drawings.pdf PDF
ATTACHMENT 10 - Site Visit Registration - Map.pdf PDF
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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36C77622B0010 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 .