EXHIBIT A CONTRACTOR EVALUATION FORM CONSTRUCTION SAFETY.pdf
PDF 57 KB Posted
- Solicitation number
- 36C25621R00291
About this file
This document contains an exhibit contractor evaluation form for construction safety and information on a related federal contract opportunity for suicide risk mitigation projects at parking garages.
The evaluation form requests safety-related information from contractors over three years, including man-hours, OSHA recordable incidents, DART rates, and any serious, willful, or repeat OSHA violations. It also asks for the contractor's safety program administrator and current EMR rating. The related federal opportunity is issued by the Department of Veterans Affairs for a design-build project to correct inaccessible fire dampers at a Veterans Health Administration facility. The solicitation number, project name and description, and issuing agency are provided.
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Text version
Exhibit A Contractor Evaluation Form
Construction Safety
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
Category 2017 2018 2019
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. (Four serious, one repeat, or one willful will lower technical rating of offeror significantly.)
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. Who administers your company’s Safety and Health Program? ______________________
3. Company’s current insurance Experience Modification Rate (EMR):___________________ http://www.osha.gov/pls/publications/publication.html
File details come from the government source that posted it. Updated .