Attachment D - Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622R0069
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract opportunity for infrastructure upgrades construction. The evaluation form requests information on a contractor's man hours, OSHA recordable incidents, DART rates, and serious safety violations over the past four years. The related federal contract opportunity is solicitation number 36C77622R0069 issued by the Department of Veterans Affairs Technology Acquisition Center Austin. It seeks a contractor to provide all labor, project management, materials, tools, and equipment for EHRM infrastructure upgrades construction in Columbia, Missouri. Relevant details include the requirement to adhere to drawings and specifications for the project work.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622R0069 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 .