Attachment II - EMR Attachment.docx
DOCX document 14 KB Posted
- Attached to
- Z2DA--Project No. 539-23-203 - Upgrade Elevators Federal contract opportunity
- Solicitation number
- 36C25023B0055
About this file
This document contains a pre-award contractor safety and environmental record evaluation form and details of a related federal contract opportunity for elevator upgrades. The evaluation form requests contractors to provide man-hour and OSHA record data from the past three years, applicable NAICS code, safety program administration details, and insurance experience modification rate. The related federal opportunity is solicitation number 36C25023B0055 from the Department of Veterans Affairs for project number 539-23-203 to upgrade elevators at an unspecified location.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 36C25023B0055 0002.docx | DOCX document | |
| 36C25023B0055 0001.docx | DOCX document | |
| 22-119 BD Specs_.pdf | ||
| 22-119 BD Dwgs.pdf | ||
| Attachment lll - RFI Attachment.docx | DOCX document | |
| Attachment l - DBA WD.pdf | ||
| Attachment IV - Limitations on Subcontracting.pdf | ||
| vha directive 1192.01.pdf | ||
| 36C25023B0055_1.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form Information provided below is current and applicable to Solicitation # 36C25023B0055 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2021 |
| 2022 |
| 2023 |
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.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
| 2. | Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________ |
| 3. | Who administers your company’s Safety and Health Program? ____________________________ |
| 4. | Company’s Insurance Experience Modification Rate (EMR): ____________________________ |
File details come from the government source that posted it. Updated .