Attachment III - EMR.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C25024Q0307
About this file
This document provides details for a federal solicitation from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10. The solicitation, numbered 36C25024Q0307, is seeking proposals to update patient showers and finishes at facility 583-24-516. Responses are due by the date specified in the solicitation. The work required includes renovating and upgrading patient shower and restroom areas and associated finishes. Interested parties should review the full solicitation for detailed requirements, response instructions, and terms and conditions of any subsequent award.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C25024Q0307 0002.docx | DOCX document | |
| 36C25024Q0307 0001.docx | DOCX document | |
| 583-24-516 Update Patient Showers and Finishes - Combined Specifications - Bid Deducts.pdf | ||
| 36C25024Q0307_1.docx | DOCX document | |
| Attachment I - Wage Determination.pdf | ||
| Attachment V - Combined Specifications.pdf | ||
| Attachment II - RFI Template.doc | DOC document | |
| Attachment IV - VHA Directive 1192-01.pdf | ||
| 36C25024Q0307_1.pdf | ||
| Attachment VI - Drawings.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 # 36C25024Q0307_1.
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| CATEGORY |
| 2020 |
| 2021 |
| 2022 |
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): ____________________________ |
File details come from the government source that posted it. Updated .