Attachment II - EMR.pdf
PDF 138 KB Posted
- Solicitation number
- 36C25023Q0431
View the file
Other files
| File | Type | Posted |
|---|---|---|
| Attachment XII - Site Walk Sign-In Sheet.pdf | ||
| Attachment X - RFI Questions and Answers.docx | DOCX document | |
| Attachment XI - TS-550 Report.pdf | ||
| 36C25023Q0431 0004.docx | DOCX document | |
| 36C25023Q0431 0003.docx | DOCX document | |
| 36C25023Q0431 0002.docx | DOCX document | |
| Attachment IX - UPDATED SOW.docx | DOCX document | |
| Site Visit Memo.docx | DOCX document | |
| 36C25023Q0431 0001.docx | DOCX document | |
| Attachment VI - UST Layout.pdf | ||
| 36C25023Q0431_1.docx | DOCX document | |
| Attachment III - DBA WD.pdf | ||
| Attachment VII - Monitoring Well Locations.pdf | ||
| Attachment I - RFI.pdf | ||
| Attachment IV - Limitations on Subcontracting (JAN 2023).pdf | ||
| Attachment VIII - UST Removal Specs.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 # 36C25023Q0431.
Company Name: ______________________________________________
Address: _____________________________________________________
Telephone: ______________________ Fax: ________________________
Email: _______________________________________________________
Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
CATEGORY 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 an 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: 236220
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR):
http://www.osha.gov/pls/publications/publication.html
Pre-Award Contractor Safety and Environmental Record Evaluation Form
File details come from the government source that posted it. Updated .