FAC114 SDO Disability Employment Practices Form.docx

34 KB Posted

Attached to
Janitorial Services, Environmentally Preferable
Contract number
FAC114
Issued by
Massachusetts

About this file

Written by GovTribe AI ·

This document is a Supplier Diversity Office (SDO) Individuals with Disabilities Pilot Program Disability Employment Practices Form, designed to assess and track employers' practices in recruiting, hiring, and supporting employees with disabilities. The form appears to be associated with a statewide contract and requires businesses to provide detailed information about their disability employment practices, workforce composition, and commitments to inclusivity.

The form focuses on collecting comprehensive data about a company's disability employment strategies, including workforce demographics, employment offer statistics, ADA coordination, recruitment and retention policies, and engagement with disability-owned businesses. Companies are required to complete this form when bidding on the contract and must provide annual updates on their progress towards disability employment goals. The document does not specify specific contract goods or services, but instead serves as a mechanism for evaluating and promoting disability employment practices across participating organizations.

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The Supplier Diversity Office (SDO) Individuals with Disabilities Pilot Program Disability Employment Practices Form

All Bidders are required to complete this form and attach it to their Quotes. In addition, on an annual basis or as required by the SST, Contractors will be required to complete this form to show progress towards Program goal.

Question
Response
1. Company name
Enter company name
2. Contact person for the SDO Disability Pilot Program
Enter contact first and last name
3. Contact phone number
Enter phone number
4. Contact email address
Enter email address
5. Form completed on (date):
Click here to enter a date
6. What industry is your company in? (Please, see www.naics.com/search/ to search codes)
Enter one NAICS code best matching your business
7. How many employees work for your company nationwide?
Enter the number of full-time equivalents (FTEs)
8. If your company employs more than 50 FTEs, what is (or, for new Bidders, expected to be) the total combined number of FTEs, regardless of disability status, involved in providing services to the Commonwealth? (Note: two staff members each spending 50% of their time providing services under the Contract equals one FTE)
Enter the number of FTEs
9. Does your company maintain company-wide statistics on the number of individuals with disabilities working within the company as a whole and/or within individual business units? (Check one)
☐ Yes, company as a whole

☐ Yes, company as a whole and each unit ☐ No

9a. If yes, approximately how many individuals with disabilities work for your company overall?
Enter the number of FTEs
9b. If yes and your company employs more than 50 FTEs, what is (or, for new Bidders, expected to be) the total combined number of FTEs staffed by individuals with disabilities involved in providing services to the Commonwealth? (Note: two staff members each spending 50% of their time providing services under the Contract shall equal one FTE)
Enter the number of FTEs
10. Does your company maintain company-wide statistics on the number of employment offers made to individuals with disabilities? (Check one)
☐ Yes

☐ No

10a. If yes, approximately how many employment offers were made to individuals with disabilities in the past year?
Enter the estimated number of offers
11. Does your company have a voluntary and confidential self-identification process for individuals with disabilities?
☐ Yes

☐ No

12. Has your business appointed an American With Disabilities Act (ADA) Coordinator, an individual responsible for ADA related accommodations, policies and other related matters? (Check one)
☐ Yes

☐ No

13. Do you currently have formal policies in place to recruit, hire, retain and/or promote persons with disabilities? (Check the boxes for all the policies that are in place)

Policies in place… ☐ To recruit individuals with disabilities ☐ To hire individuals with disabilities ☐ To retain individuals with disabilities ☐ To promote individuals with disabilities ☐ None of the above

13a. If yes for at least one policy, attach the appropriate policy to your response.

14. Do you have a grievance policy or procedure to utilize for reasonable accommodations for your employees? (Check one)
☐ Yes

☐ No

15. Has your organization participated in any community event or other engagement relative to persons with disabilities? (Check one)
☐ Yes

☐ No

16. What other policies, practices, procedures, systems, and initiatives does your company have in place to enable the recruitment, hiring, promotion and retention of individuals with disabilities?
Describe the policies, practices, procedures, systems and initiatives
17. What other policies, practices, procedures, systems, and initiatives does your company propose to implement to enable the recruitment, hiring, promotion and retention of individuals with disabilities under this Statewide contract?
Describe the policies, practices, procedures, systems and initiatives
18. Does your company have a business relationship with one or more business that is disability-owned or employs a significant number of individuals with disabilities?
☐ Yes, a disability-owned business

☐ Yes, a business employing a significant number of individuals with disabilities ☐ No

18a. If yes, please provide information the contact information for the business(es).
Provide business name, contact name, phone number and email
18b. If yes, please describe the products/services supplied by the business(es).
Describe products/services supplied by the business(es)

Revised 03/16/2021

File details come from the government source that posted it. Updated .