Attachment II - EMR.pdf
PDF 139 KB Posted
- Attached to
- Z1DA--Upgrade Landscaping 610A4-23-204
- Solicitation number
- 36C25024Q0199
About this file
This document contains a pre-award contractor safety evaluation form and information on a related federal contract opportunity for landscaping upgrade services. The evaluation form requests safety-related information over the past three years, including man-hours, OSHA recordable incidents, days away from work rates, and serious violations. It also asks for the company's NAICS code and details on its safety program administration and experience modification rate. The related federal opportunity is issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 for landscaping upgrade services at location 610A4-23-204.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25024Q0199 0003.docx | DOCX document | |
| 36C25024Q0199 0002.docx | DOCX document | |
| 36C25024Q0199 0001.docx | DOCX document | |
| ATTACHMENT VII - Drawings.pdf | ||
| ATTACHMENT III - VHA Directive 1192 01.pdf | ||
| Attachment IV - Limitations on Subcontracting (JAN 2023).pdf | ||
| ATTACHMENT VI - Specification Book.pdf | ||
| 36C25024Q0199.docx | DOCX document | |
| ATTACHMENT V - WD - DBA Fort Wayne 2024.pdf | ||
| Attachment I - RFI Template.pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
The information provided below is current and applicable to Solicitation # 36C25024Q0199.
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 (job site and office).
Number of cases involving days away from work, restricted activity, or both (Columns 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 a 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):
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 .