CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY.docx
DOCX document 27 KB Posted
- Attached to
- K067--586-21-2-1559-0003 - Project 586-19-101 Design Build CCTV Upgrade (Non-OIT) - 36C256-21-AP-0026
- Solicitation number
- 36C25621R0086
View the file
Other files
| File | Type | Posted |
|---|---|---|
| 36C25621R0086 0001.docx | DOCX document | |
| S02 Draft 36C25621R0086-final.pdf | ||
| Wage Determination.pdf | ||
| Statement of Work.pdf | ||
| 36C25621R0086.docx | DOCX document | |
| CCTV FLOOR PLAN.pdf | ||
| Updated Statement of Work.pdf |
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
FOR OFFICIAL USE ONLY
36C25621R0086
Exhibit A Contractor Evaluation Form Construction Safety
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. (Four serious, one repeat, or one willful may disqualify the contractor.)
****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. Who administers your company’s Safety and Health Program?
3. Company’s current Insurance Experience Modification Rate (EMR):____________________________
File details come from the government source that posted it. Updated .