EMR.docx
DOCX document 14 KB Posted
- Attached to
- Z1DA--Improve Trailers 539-22-209 Federal contract opportunity
- Solicitation number
- 36C25023B0041
About this file
This document contains a pre-award contractor safety and environmental record evaluation form and information on a related federal contract opportunity for trailer improvements at the Cincinnati VA Medical Center. The evaluation form requests a contractor's OSHA 300 forms and injury rates for the past three years, NAICS code, safety program administrator, and experience modification rate. The related federal contract opportunity is solicitation number 36C25023B0041 to provide construction services including labor, materials, equipment, and supervision to complete repairs and upgrades to existing trailers at the Cincinnati VAMC campus. This will ensure the trailers are kept in a safe and operable condition for continued daily use by patients and employees. The awarded contractor must fulfill the project requirements.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| 539-22-209 Pre-Bid Site Visit Sign-in Sheet (5-30-23).pdf | ||
| 36C25023B0041 0001.docx | DOCX document | |
| 539-22-209 Bid Drawings 2023-02-23.pdf | ||
| WD OH20230082.pdf | ||
| VHA_Directive_1192.pdf | ||
| Attachment 3 - VAAR 852.219-75 VA Notice of Limitations on Subcontracting (JAN 2023).pdf | ||
| 36C25023B0041_2.pdf | ||
| 539-22-209 Bid Specifications 2023-02-23.pdf | ||
| RFI Form-36C25023B0041.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form Information provided below is current and applicable to Solicitation # 36C25023B0041.
Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2022 |
| 2021 |
| 2020 |
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 .