Contractor EMR_626-24-509 - Repair ACRE North Stairwell.docx
DOCX document 16 KB Posted
- Solicitation number
- 36C24924B0010
About this file
This document is a Pre-Award Contractor Safety and Environmental Record Evaluation Form for Solicitation 36C24924B0010 for Project #626-24-509 Repair ACRE North Stairwell, issued by the Department of Veterans Affairs Veterans Health Administration Veterans Integrated Service Network 9.
The form requires the contractor to provide their OSHA 300 Form data for the past 3 years, including the number of man hours, cases involving days away from work, restricted activity or both, days away, restricted or transferred rate, and any OSHA violations. The contractor must also provide their North American Industrial Classification System (NAICS) code, the administrator of their safety and health program, and their Insurance Experience Modification Rate (EMR). The purpose is to evaluate the contractor's safety and environmental record as part of the pre-award process for this federal contract opportunity.
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Other files
| File | Type | Posted |
|---|---|---|
| 36C24924B0010 0002.docx | DOCX document | |
| 36C24924B0010 0001.docx | DOCX document | |
| RFI Form_626-24-509 - Repair ACRE North Stairwell.docx | DOCX document | |
| 36C24924B0010_1.docx | DOCX document | |
| P07-Wage Determination_TN20240178 03-22-2024.pdf | ||
| C28_Drawings_626-24-509 REPAIR NORTH ACRE STAIRWELL .pdf | ||
| UEI _ TAX ID.docx | DOCX document | |
| C27_626-24-509 Specs.pdf | ||
| S02-CALCULATION OF SELF PERFORMED WORK_626-24-509 - Repair ACRE North Stairwell.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation 36C24924B0010
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 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): ____________________________
File details come from the government source that posted it. Updated .