EMR B0017.pdf
PDF 78 KB Posted
- Solicitation number
- 36C24922B0017
About this file
This document contains a pre-award contractor safety and environmental record evaluation form and details of a related federal contract opportunity for project 621-22-125 to rehabilitate Dogwood Avenue and other campus surfaces at the James H. Quillen VA Medical Center.
The evaluation form requests contact information and safety data including man hours, OSHA recordable incidents, injury rates, and violations over the past three years. It also asks for NAICS code, safety program administrator, and experience modification rate. The federal contract opportunity provides additional context, seeking all labor, materials, and supervision to rehabilitate roads and parking lots on the VA medical center campus.
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Other files
| File | Type | Posted |
|---|---|---|
| C01 Award Notice.pdf | ||
| 36C24922B0017 0003.pdf | ||
| S04 Attendance for site visit 4-13-22.pdf | ||
| 36C24922B0017 0002.pdf | ||
| 36C24922B0017 0001.pdf | ||
| 621-22-125 SPECS - REV.pdf | ||
| D-003 EPSC - Revised 2022.04.25.pdf | ||
| 621-22-125 Curb Details and Quantities.pdf | ||
| App D Draft EA docs for 100 percent.pdf | ||
| RFI Form - Rehabilitate Dogwood Ave.pdf | ||
| Header - List of Attachments.txt | TXT text file | |
| Drawings.pdf | ||
| Specs Part3.pdf | ||
| 36C24922B0017_1.docx | DOCX document | |
| WD TN20220147 2-25-22.pdf | ||
| Specs Part2.pdf | ||
| Specs part 1.pdf |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation: 36C24922B0017 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2019 2020 2021
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
2. Provide six-digit North American Industrial Classification System (NAICS) Code for this acquisition: __________________________________
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate
(EMR): ____________________________
File details come from the government source that posted it. Updated .