Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77622B0030
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal solicitation for construction work. The evaluation form requests information on a contractor's man hours, OSHA recordable incidents, DART rates, and any serious violations over the past three years.
The related solicitation is for infrastructure upgrade construction services at the Fargo VA Health Care System campus in North Dakota. The project scope includes demolition, new construction, mechanical, electrical, fire protection systems, asbestos abatement, and other work to upgrade the entire IT infrastructure to current VA and industry standards while minimizing downtime. The solicitation was issued by the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0030 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 .