S02 - ATTACHMENT 10 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Solicitation number
- 36C77621B0021
About this file
This document contains a contractor safety and environmental record evaluation form and information on a related federal contract opportunity for remodeling and HVAC work at a Veterans Affairs medical center. The evaluation form requests a contractor's OSHA 300 form information for the last four years, including total man hours, days away from work cases, restricted duty cases, and serious OSHA violations. The related solicitation is for remodeling specialty care areas and correcting HVAC issues in Building 19 at the Martinez VA Medical Center in California. The contractor must provide all labor, materials, equipment, supervision, and work necessary to complete the construction project per the attached specifications and drawings. The federal agency issuing this opportunity is the Department of Veterans Affairs Technology Acquisition Center located in Austin, Texas.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77621B0021 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 2019 |
| 2020 |
| 2021 |
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.
File details come from the government source that posted it. Updated .