Attachment_D-Safety_Form.docx
DOCX document 16 KB Posted
- Attached to
- 8(a) Multiple Award Construction Contract (8(a) MACC), NAVFAC Washington Federal contract opportunity
- Solicitation number
- N4008017R0020
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Attachment_D-Safety_Form.docx
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| Amendment_0003.pdf | ||
| Site_Visit.pdf | ||
| Amendment_0002.pdf | ||
| Attachment_B-NAVFAC_Past_Performance_Questionnaire.docx | DOCX document | |
| Attachment_C-P311_Specs_Final_Set_(signed).pdf | ||
| Attachment_A-Construction_Experience.docx | DOCX document | |
| 8(a)MACC_General_Construction_Solicitation.pdf | ||
| N4008017R0020_Pre-Solicitation_Notice_for_N40080-17-R-0020_8(a)_MACC.pdf |
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Text version
Attachment “D”
SAFETY FORM – OFFEROR
SOLICITATION #N40080-17-R-0020
This form is to be completed by the Offeror. Use this form to provide information for Factor 2, Safety. The Offeror SHALL submit the following information: Experience Modification Rate (EMR), OSHA Days Away from Work, Restricted Duty, or Job Transfer (DART) for the three (3) previous complete calendar years, and Technical Approach for Safety. For a partnership or joint venture, the following submittal requirements are required for each Contractor who is part of the partnership or joint venture. EMR and DART Rates shall not be submitted for subcontractors.
| 1. |
| Offeror Name: |
| 2. |
| EMR : |
| YEAR |
| 2014 |
| 2015 |
| 2016 |
RATE
| 3. |
| OSHA DART : |
| YEAR |
| 2014 |
| 2015 |
| 2016 |
RATE
| 4. |
| If Offer cannot provide EMR or OSHA DART Rate, affirmatively state so, and explain why: |
| 5 |
| Technical Approach for Safety: |
(The Safety Narrative shall be limited to two pages.)
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