Attachment IV - EMR.pdf
PDF 138 KB Posted
- Attached to
- Z1DA--Data and Power Requirements Contract Federal contract opportunity
- Solicitation number
- 36C25023R0228
About this file
This document contains a pre-award contractor safety evaluation form and information on a related federal contract opportunity for data and power requirements. 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, safety program administrator, and experience modification rate. The related federal contract opportunity is from the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 10 and seeks bids for a data and power requirements contract under solicitation number 36C25023R0228.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Attachment XIV - 2nd Set RFI Questions AND Answers.pdf | ||
| 36C25023R0228 0004.pdf | ||
| 36C25023R0228 0003.docx | DOCX document | |
| Attachment XII - UPDATED SOW.docx | DOCX document | |
| Attachment XI - Price Cost Schedule UPDATED.docx | DOCX document | |
| ATTACHMENT XIII - RFI Questions AND Answers.docx | DOCX document | |
| 36C25023R0228 0002.docx | DOCX document | |
| 36C25023R0228 0001.docx | DOCX document | |
| ATTACHMENT X - Construction Waste Management Spec.pdf | ||
| ATTACHMENT IX - PAST PERFORMANCE TEMPLATE.pdf | ||
| ATTACHMENT VIII - General Specs.pdf | ||
| Attachment V - Limitations on Subcontracting (JAN 2023).pdf | ||
| Attachment III - RFI Template.pdf | ||
| ATTACHMENT II - VHA Directive 1192 01.pdf | ||
| 36C25023R0228_2.docx | DOCX document | |
| Attachment I - DBA WD.pdf | ||
| ATTACHMENT VII - Electrical Specs.pdf | ||
| Attachment VI - Data Specs.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 # 36C25023R0228.
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: 238210
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 .