ATTACHMENT 9 - Contractor Safety - Environmental Form.docx

DOCX document 14 KB Posted

Attached to
Y1AZ--EHRM Training and Administrative Support Space Construction - St. Cloud Federal contract opportunity
Solicitation number
36C77622B0026
Issued by
Department of Veterans Affairs Technology Acquisition Center Austin

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This document contains a contractor safety and environmental record evaluation form and information on a related federal contract opportunity for construction services. The evaluation form requests a contractor provide man hours, OSHA recordable incidents, rates, and violations for the past four years. The related solicitation is for a general contractor to renovate the EHRM Training Room and Administrative Support Space at the St. Cloud VAMC. Work includes general construction, alterations, removal of existing structures, millwork, permanently mounted equipment, interior finishes, and other items. The agency is the Department of Veterans Affairs Technology Acquisition Center Austin.

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Other files for this federal contract opportunity

Other files attached to Y1AZ--EHRM Training and Administrative Support Space Construction - St. Cloud, newest first.
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Technical Questions - FINAL - St. Cloud 5-23-22.pdf PDF
Response 29 - EF101A.pdf PDF
Response 46 - ELPD 101.pdf PDF
36C77622B0026 0003.pdf PDF
Response 2 - 21 08 00 Commissioning of Fire Suppression Systems.pdf PDF
Response 29 - 21 13 13 Wet-Pipe Sprinkler Systems Revised.pdf PDF
Response 29 - FX-101 Revised.pdf PDF
Response 45 - GI000 Supplement.pdf PDF
Response 15 - 23 09 23 Direct-Digital Control System for HVAC.pdf PDF
Response 43 - B-04 EHRM-HA101.pdf PDF
Response 43 - DSCF2239.pdf PDF
Response 45 - GC100 Supplement.pdf PDF
Response 17 - 01 45 29 Testing Laboratory Services Revised.pdf PDF
36C77622B0026 0002.pdf PDF
ATTACHMENT 8 - Construction Wage Rates - Stearns 4-1-22.pdf PDF
Site Visit Sign-In Sheet 4-19-22.pdf PDF
36C77622B0026 0001.pdf PDF
ATTACHMENT 3 - Drawings 2 of 2.pdf PDF
36C77622B0026 - 4-7-22.pdf PDF
ATTACHMENT 2 - Drawings 1 of 2.pdf PDF
ATTACHMENT 4 - Brand Name Justification - St. Cloud.pdf PDF
ATTACHMENT 6 - COVID-19 Safety Protocols 12-14-21.pdf PDF
ATTACHMENT 1 - Specifications.pdf PDF
ATTACHMENT 7 - Limitations on Subcontracting - Construction.docx DOCX document
ATTACHMENT 8 - Construction Wage Rates - Stearns 2-25-22.pdf PDF
ATTACHMENT 10 - Site Visit Instructions.pdf PDF
ATTACHMENT 5 - Contractor Core Work Hours.pdf PDF
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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36C77622B0026 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 .