Contractor Safety Eval Pre-Qual Questionnaire.pdf
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- Attached to
- One Waterfront Place Dry Coolers Replacement
- Solicitation number
- RFB202690000664
- Issued by
- Mingo County, West Virginia
About this file
The document is a Contractor Safety Evaluation Pre-Qualification Questionnaire from West Virginia University's Procurement, Contracting and Payment Services department. The form is designed to assess a contractor's safety record and practices, with specific evaluation criteria including the company's Experience Modification Rate (EMR), OSHA log information for the past three years, and detailed safety management practices. The questionnaire requires contractors to provide information on their written safety program, safety leadership, job site audits, employee training, and any OSHA citations.
Key evaluation points include a mandatory EMR threshold of 1.20, with rates above this not being considered, and comprehensive safety management inquiries such as having a full-time Safety Director, conducting job site audits, holding "Tool Box Talks", requiring OSHA 30-hour training for employees, and maintaining a safety training program for foremen. The document, created in May 2016, serves as a pre-qualification screening tool to ensure potential contractors demonstrate a strong commitment to workplace safety and have robust safety management systems in place before being considered for contract work with West Virginia University.
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Procurement, Contracting and Payment Services
Phone: 304-293-5711 Fax: 304-293-8152
150 Clay Street, 2nd Floor PO Box 6024 Morgantown WV 26506-6024
Created May 2016
Contractor Safety Evaluation Pre-Qualification Questionnaire
1. List your company’s Experience Modification Rate (EMR) for the past three years; an EMR of 1.20 will not be considered.
Year: Year: Year:
EMR: EMR: EMR:
2. List the following OSHA Log Information for the past three years:
OSHA Log Information Year: Year: Year:
Total Recordable
Lost Work Days Cases
Lost Work Days
Total Employee Hours Worked
Number of Fatalities
(Circle the applicable answer)
3. Do you have a written Safety Program?................................................................................................................................................Yes No
150 Clay Street, 2nd Floor PO Box 6024 Morgantown WV 26506-6024
Phone: 304-293-5711 Fax: 304-293-8152
Created May 2016
4. Do you have a full time Safety Director?................................................................................................................................................Yes No
a. If not, who is in charge of safety and what are their primary roles in this capacity?
5. Do you conduct job site audits?............................................................................................................................................................Yes No
a. By Whom?
b. How Often?
c. Is this documented? ?...............................................................................................................................................................Yes No
6. Do you hold “Tool Box Talks” for employees?.......................................................................................................................................Yes No
a. How Often?
b. Is this documented? ?...............................................................................................................................................................Yes No
7. Do you require employees to have OSHA 30-hour training?.................................................................................................................Yes No
8. Do you have a safety training program for the foreman?.................................................................................................Yes No
a. If yes, what does this include?
150 Clay Street, 2nd Floor PO Box 6024 Morgantown WV 26506-6024
Phone: 304-293-5711 Fax: 304-293-8152
Created May 2016
9. Has OSHA cited you in the past three years?.......................................................................................................................................Yes No
a. If yes, explain in detail (Add more pages as necessary):
File details come from the government source that posted it. Updated .