EMR 1 Page.pdf

This is a Pre-Award Contractor Evaluation Form (EMR Form) that bidders and offerors must complete and submit with their proposals.

The form requires contractors to provide company identification information including name, address, telephone, fax, email, and primary contact. Contractors must complete OSHA 300 Form data for four years (2022-2025) documenting: total man hours worked at jobsite and office locations; number of cases involving days away from work, restricted activity, or both; the Days Away, Restricted, or Transferred (DART) rate calculated as the number of such cases multiplied by 200,000 divided by total man hours; and the number of serious, willful, or repeat violations from OSHA within the past three years with required explanations. Contractors must also provide their six-digit North American Industrial Classification System (NAICS) Code, identify who administers their Safety and Health Program, and disclose their Insurance Experience Modification Rate (EMR) for the past three years. A contractor is disqualified if they have four serious violations, one repeat violation, one willful violation, or an EMR greater than 1.0. Copies of OSHA 300 and 300a Forms must be attached to the submission and are available through the OSHA publications search page.