Attachment II - EMR.pdf
PDF 479 KB Posted
- Attached to
- Repair FTD Building Envelope 539-25-509 Federal contract opportunity
- Solicitation number
- 36C25026Q0047
About this file
This is a Pre-Award Contractor Safety and Environmental Record Evaluation Form for Solicitation #36C25026Q0047. The form requires potential contractors to provide detailed safety performance information, including OSHA-related documentation for the years 2021-2023. Specific data points requested include number of man hours, workplace injury cases, Days Away, Restricted, or Transferred (DART) rate, and the number of serious, willful, or repeat OSHA violations. Additionally, contractors must provide their six-digit North American Industrial Classification System (NAICS) Code, information about who administers their Safety and Health Program, and their Insurance Experience Modification Rate (EMR). The form instructs contractors to attach copies of their OSHA 300 and 300a Forms, which can be accessed through the OSHA publications search page.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment I - RFI Video.mp4 | MP4 file | |
| Attachment II -Shotcrete Addendum.docx | DOCX document | |
| 36C25026Q0047 0002.pdf | ||
| 36C25026Q0047 0001.pdf | ||
| Attachment I - DBA.pdf | ||
| Attachment VI - Specs.pdf | ||
| Attachment III - RFI.pdf | ||
| Attachment IV - Limitation on Subcontracting Cert.pdf | ||
| Attachment VII - FtThomas.pdf | ||
| 36C25026Q0047_1.pdf | ||
| Attachment V - vha directive 1192.01.pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation # 36C25026Q0047
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 .