Contractor Safety Eval Pre Qual Questionnaire.pdf
PDF 53 KB Posted
- Attached to
- Dreamswork Field Sod Replacement
- Solicitation number
- RFB202690000686
- Issued by
- Mingo County, West Virginia
About this file
This is a Contractor Safety Evaluation Pre-Qualification Questionnaire from the Procurement, Contracting and Payment Services division of West Virginia, created in May 2016. The document serves as a pre-qualification tool for contractors bidding on state and local contracts in West Virginia, specifically related to the Dreamswork Field Sod Replacement project in Morgantown, WV, which requires removal and replacement of sod field. The questionnaire requires contractors to provide their Experience Modification Rate (EMR) for the past three years, with a maximum threshold of 1.20, and to submit detailed OSHA Log Information including total recordable cases, lost work days, total employee hours worked, and number of fatalities over the same three-year period.
The questionnaire evaluates contractor safety program maturity through nine primary assessment areas: the existence of a written safety program, designation of a full-time safety director, implementation of job site audits with documentation, frequency and documentation of employee tool box talks, OSHA 30-hour training requirements for employees, foreman safety training programs, and disclosure of any OSHA citations within the past three years with detailed explanations. Contractors must provide comprehensive responses regarding their safety infrastructure, training protocols, and compliance history. This pre-qualification assessment indicates that safety performance and documentation are critical evaluation criteria for contractor selection on West Virginia state and local construction projects, with submission of this completed questionnaire required before contractors can proceed in the bidding process.
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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 .