Contractor Safety Eval Pre-Qual Questionnaire.pdf
PDF 53 KB Posted
- Attached to
- PSC - Library Boiler Replacement
- Solicitation number
- RFB202690000713
- Issued by
- Mingo County, West Virginia
About this file
This is a Contractor Safety Evaluation Pre-Qualification Questionnaire issued by the Procurement, Contracting and Payment Services department of West Virginia for the PSC Library Boiler Replacement project at the Mary F. Shipper Library on the Potomac State College campus in Keyser, WV. The questionnaire is designed to evaluate contractor safety qualifications and requires submission of specific safety documentation and information prior to contract award. Contractors must provide their Experience Modification Rate (EMR) for the past three years, with an EMR exceeding 1.20 disqualifying them from consideration. Additionally, contractors must submit OSHA Log Information for the past three years, including total recordable cases, lost work days, total employee hours worked, and number of fatalities.
The questionnaire requires detailed responses regarding contractors' safety programs and practices, including whether they maintain a written safety program, employ a full-time safety director, conduct jobsite audits with documentation, hold documented toolbox talks, require OSHA 30-hour training for employees, and provide safety training programs for foremen. Contractors must also disclose any OSHA citations received within the past three years with detailed explanations if applicable. This pre-qualification assessment establishes minimum safety standards that contractors must meet to be eligible for bidding on the boiler replacement project, with responses evaluated based on safety performance history and documented safety management practices.
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Text version
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 .