Exhibit F - Safety Evaluation.pdf
PDF 77 KB Posted
- Attached to
- HSC South Elevator Modernization
- Solicitation number
- RFP202590000654
- Issued by
- West Virginia
About this file
The document is a Contractor Safety Evaluation Pre-Qualification Questionnaire issued by West Virginia University's Procurement, Contracting and Payment Services for the HSC South Elevator Modernization project. The form is designed to comprehensively assess a contractor's safety record and practices, requiring detailed information about the company's Experience Modification Rate (EMR), OSHA log information for the past three years, safety program documentation, and safety management approach.
The questionnaire seeks in-depth insights into the contractor's safety protocols, including the existence of a full-time Safety Director, job site audit practices, "Tool Box Talks" frequency, employee OSHA 30-hour training requirements, foreman safety training programs, and any OSHA citations in the past three years. A key qualifying criterion is maintaining an EMR below 1.20, which indicates the contractor's workplace safety performance relative to industry standards. The form is structured to help West Virginia University evaluate and pre-qualify contractors based on their commitment to workplace safety and risk management before awarding the elevator modernization contract.
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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 .