S02 Atch 5 Contractor EMR Certification Form.docx
DOCX document 17 KB Posted
- Solicitation number
- 36C24925B0002
About this file
The document is a Pre-Award Contractor Safety and Environmental Record Evaluation Form for Solicitation 36C24925B0002, associated with a construction project at the Tennessee Valley Healthcare System (TVHS). The form requires contractors to provide detailed safety and health information, including OSHA 300 form data for 2022-2024, such as man-hours, workplace injury cases, DART rates, and OSHA violations. Additionally, contractors must submit their NAICS code (236220 - Commercial and Institutional Building Construction), identify who administers their safety program, and disclose their Insurance Experience Modification Rate (EMR).
The related federal contract opportunity is a construction project for the Department of Veterans Affairs at the Nashville VAMC, involving an Apheresis-Mohs Storage Room Compliance Upgrade. The project requires installing three constant volume DDC VAV boxes, associated ductwork, re-heat piping, and control system connections. The period of performance is 60 calendar days from the Notice to Proceed, with work primarily conducted during specified hours to minimize disruption to medical center operations. Contractors must comply with strict safety regulations, provide daily reports, obtain VA contractor identification badges, and maintain a clean work environment throughout the project.
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Other files
| File | Type | Posted |
|---|---|---|
| S06_36C24925B0002 0002_626-25-102 - Apheresis-Mohs Storage Room Compliance Upgrade.pdf | ||
| 36C24925B0002 0001.docx | DOCX document | |
| S02 Atch 6 General Conditions Breakout.xlsx | XLSX spreadsheet | |
| S02 Atch 1 WD Davidson County Building TN20250178 dated 03142025.pdf | ||
| S02 Atch 7 Price Breakout Schedule.xlsx | XLSX spreadsheet | |
| S02 Atch 4 Calculation of Contractor Self Performed Work.xlsx | XLSX spreadsheet | |
| S02 Atch 2 Drawings Final.pdf | ||
| S02 Atch 3 Specification 03132025.pdf | ||
| 36C24925B0002_1.docx | DOCX document | |
| S02 Atch 8 RFI Form.docx | DOCX document |
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Text version
Pre-Award Contractor Safety and Environmental Record Evaluation Form
Information provided below is current and applicable to Solicitation: 36C24925B0002
Company Name:
Address:
Telephone: Fax:
Email:
Contact:
1. Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2022 |
| 2023 |
| 2024 |
Number of man hours (jobsite and office).
Number of cases involving days away from work, restricted activity, or both (Column H and I of OSHA 300).
Days away, restricted, or transferred rate (# of days away, restricted, or transferred cases x 200,000/# of man hours) (DART Rate).
Number of serious, willful, or repeat violations from OSHA within the last 3 years. Please attach explanation for any violations.
Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page: http://www.osha.gov/pls/publications/publication.html.
2. Provide your six-digit North American Industrial Classification System (NAICS) Code for this acquisition: 236220 – Commercial and Institutional Building Construction
3. Who administers your company’s Safety and Health Program?
4. Company’s Insurance Experience Modification Rate (EMR):
File details come from the government source that posted it. Updated .