Exhibit J - Safety Evaluation.pdf
PDF 59 KB Posted
- Solicitation number
- RFP202690000697
- Issued by
- Mingo County, West Virginia
About this file
This is a Contractor Safety Evaluation Pre-Qualification Questionnaire created by the Procurement, Contracting and Payment Services division of West Virginia for the Evansdale Crossing Third and Fourth Floor Renovations project in Morgantown. The document serves as a pre-qualification assessment tool for contractors bidding on renovation work to the third and fourth floors at Evansdale Crossing on the Evansdale Campus. The questionnaire evaluates contractor safety qualifications and historical performance across multiple dimensions to ensure bidders meet minimum safety standards before contract award.
The questionnaire requires contractors to submit three years of Experience Modification Rate (EMR) data, with a maximum allowable EMR of 1.20, along with detailed OSHA log information including total recordable cases, lost work days, total employee hours worked, and fatalities. Contractors must provide information regarding their written safety programs, full-time safety director availability, job site audit procedures and frequency, tool box talk implementation and documentation, OSHA 30-hour training requirements for employees, foreman safety training programs, and any OSHA citations received within the past three years. This comprehensive pre-qualification process establishes minimum safety performance thresholds and institutional safety practices that contractors must demonstrate to be considered eligible for the renovation project.
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Text version
Created May 2016 Phone: 304-293-5711 Fax: 304-293-8152
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
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
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):
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