Attachment 9 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- C1BG--550-21-703 EHRM Training and Administrative Space Support Danville (VA-22-00050156)
- Solicitation number
- 36C77622B0049
About this file
This document contains a contractor safety and environmental record evaluation form and details of a related federal contract solicitation. The evaluation form requests company information and safety data from OSHA 300 forms including man hours, injury cases, days away from work rates, and serious violations over the past four years.
The related solicitation is for EHRM administrative and training space support services at a VA facility in Danville, Illinois. Solicitation number 36C77622B0049 has an opportunity type of solicitation and is being issued by the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas. The description indicates it is for administrative and training space support at the specified VA location and refers to attached specifications and instructions for additional requirement details.
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Other files
| File | Type | Posted |
|---|---|---|
| Danville RFI.docx | DOCX document | |
| EHRM Haul Route.pdf | ||
| 36C77622B0049 0003.docx | DOCX document | |
| 36C77622B0049 0002.docx | DOCX document | |
| 36C77622B0049 0001.docx | DOCX document | |
| Attachment 3-550-21-703 Bid Schedule.docx | DOCX document | |
| Attachment 7 - Limitations on Subcontracting - Construction.docx | DOCX document | |
| Attachment 4-550-21-703 - 21_10_20 - Bid Estimate.pdf | ||
| Attachment 6 - COVID-19 Safety Protocols 12-14-21.pdf | ||
| Attachment 5-550-21-703 - Bid Drawings.pdf | ||
| 36C77622B0049_1.docx | DOCX document | |
| Attachment 8- Construction Wage Rates Vermillion.pdf | ||
| Attachment 2-550-21-703 SOW Synopsis.docx | DOCX document | |
| Attachment 1-550-21-703 - 21_10_20 - Bid Specs.pdf |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0049 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 .