Attachment 9 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0038
About this file
This is an evaluation form for contractor safety and environmental records submitted in response to solicitation number 36C77622B0023 from the Department of Veterans Affairs Technology Acquisition Center Austin. The form requests company identifying information and OSHA 300 data including man hours, cases involving days away from work or restricted activity, days away restricted or transferred rate, and any serious, willful, or repeat OSHA violations from the last three years along with explanations for any violations. Relatedly, solicitation 36C77622B0038 from the Department of Veterans Affairs Technology Acquisition Center Austin seeks proposals to expand radiation therapy capabilities at the Jamaica Plain Campus. No other details are provided on products, services, pricing, or response dates for that opportunity.
View the file
Other files
Show all 19
On GovTribe
Work with this file
- 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 36C77622B0023 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 .