Contractor Safety and Environmental Form.docx
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- Attached to
- Y1DA--589A7-21-702 EHRM Training and Admin Support Space (TASS) Construction - Wichita, KS
- Solicitation number
- 36C77622B0033
About this file
This document contains a contractor safety and environmental record evaluation form as well as details of a federal contract opportunity for construction services. The evaluation form requests safety-related information from contractors such as total man hours, OSHA recordable incidents, days away from work rates, and serious violations over the past three years.
The related federal contract opportunity is solicitation number 36C77622B0033 from the Department of Veterans Affairs Technology Acquisition Center Austin. It seeks a general contractor to complete renovations of approximately 12,000 square feet on the ground level of Building 61 at the Robert J. Dole VA Medical Center in Wichita, Kansas. The project is to furnish all labor, materials, equipment, qualified supervision, and other items designated in the contract specifications and drawings to establish an EHRM Training and Admin Support Space.
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0033 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 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.
File details come from the government source that posted it. Updated .