Exhibit F - Safety Evaluation.pdf
PDF 77 KB Posted
- Attached to
- HSC North Elevator Modernization
- Solicitation number
- RFP202590000655
- Issued by
- West Virginia
About this file
This document is a Contractor Safety Evaluation Pre-Qualification Questionnaire issued by West Virginia University's Procurement, Contracting and Payment Services for the HSC North Elevator Modernization project. The form is designed to assess a contractor's safety record and practices, with specific sections requiring detailed information about the company's Experience Modification Rate (EMR), OSHA log information for the past three years, safety program documentation, safety leadership, job site audit procedures, employee training, and any OSHA citations.
The questionnaire critically evaluates a contractor's safety performance, with key screening criteria including an EMR less than 1.20, the presence of a written safety program, job site audit practices, "Tool Box Talks" frequency, OSHA 30-hour training requirements for employees, and safety training for foremen. Contractors must provide comprehensive documentation about their safety protocols, including who conducts job site audits, how often safety meetings are held, and whether these activities are formally documented. The form serves as a pre-qualification mechanism to ensure that only contractors with robust safety practices are considered for the elevator modernization project at the WVU Health Sciences Center North.
View the file
Other files
Show all 12
On GovTribe
Work with this file
- Download the original file
- Contacts named in this file
- Similar government files
- Ask GovTribe AI about this file
Text version
Created May 2016 Phone: 304-293-5711 Fax: 304-293-8152
One Waterfront Place, 3rd Floor PO Box 6024 Morgantown WV 26506-6024
Procurement, Contracting and Payment Services
Contractor Safety Evaluation Pre-Qualification Questionnaire
1. List your company’s Experience Modification Rate (EMR) for the past three years; an EMR greater than 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
Contractor: ___________________
Created May 2016
Phone: 304-293-5711
One Waterfront Place, 3rd Floor PO Box 6024 Morgantown WV 26506-6024
Procurement, Contracting and Payment Services
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?
Created May 2016
Phone: 304-293-5711
One Waterfront Place, 3rd Floor PO Box 6024 Morgantown WV 26506-6024
Procurement, Contracting and Payment Services
9. Has OSHA cited you in the past three years?.......................................................................................................................................Yes No
a. If yes, explain in detail (Add more pages as necessary):
File details come from the government source that posted it. Updated .