Contractor Safety Eval Pre Qual Questionnaire.pdf
PDF 61 KB Posted
- Attached to
- Chestnut Ridge Building Roof Renovations
- Solicitation number
- RFB202690000722
- Issued by
- Mingo County, West Virginia
About this file
This is a Contractor Safety Evaluation Pre-Qualification Questionnaire issued by West Virginia University's Procurement, Contracting and Payment Services office for contractors bidding on the Chestnut Ridge Building Roof Renovations project in Morgantown, West Virginia. The questionnaire requires prospective contractors to submit comprehensive safety documentation and information covering the past three years, including Experience Modification Rates (EMRs), with a maximum threshold of 1.20, and detailed OSHA Log Information such as total recordable cases, lost work days, total employee hours worked, and number of fatalities. Additionally, contractors must provide written responses regarding the presence of formal safety programs, full-time safety directors, job site audit procedures, employee tool box talks, OSHA 30-hour training requirements, foreman safety training programs, and any OSHA citations received during the three-year period.
This pre-qualification document establishes safety compliance standards as a condition of contract eligibility for roofing work on the Chestnut Ridge Building. The questionnaire does not specify pricing terms, contract award dates, or project completion timelines; rather, it functions as a gatekeeping mechanism to ensure that only contractors meeting West Virginia University's safety benchmarks and documentation requirements are permitted to proceed in the bidding process. The document was created in May 2016 and represents the university's commitment to contractor safety accountability and risk mitigation on construction projects.
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Procurement, Contracting and Payment Services
Phone: 304-293-5711 Fax: 304-293-8152
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?
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):
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