Attachment_D_Safety_Form.docx
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- N4008018R0007
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Attachment “D”
SAFETY FORM – OFFEROR
SOLICITATION #N40080-18-R-0007
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: (For a partnership or joint venture, the following submittal requirements are required for each Contractor who is part of the partnership or joint venture. TRC and DART Rates shall not be submitted for subcontractors.)
| 1. |
| Offeror Name: |
| 2. |
| OSHA TRC: |
| YEAR |
| 2015 |
| 2016 |
| 2017 |
RATE
| 3. |
| OSHA DART : |
| YEAR |
| 2015 |
| 2016 |
| 2017 |
RATE
| 4. |
| If Offer cannot provide OSHA TRC or OSHA DART Rate, affirmatively state so, and explain why: |
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