S02 Attachment 10_EMR_1 Page.pdf

This is a Pre-Award Contractor Evaluation Form (EMR Form) required to be completed and submitted with a proposal for federal contracting opportunities.

The form requires bidders and offerors to provide company identification information including name, address, telephone, fax, email, and contact person. Contractors must complete OSHA 300 Form data for the years 2022 through 2025, reporting: total man hours worked at jobsites and offices; number of cases involving days away from work, restricted activity, or both (per OSHA 300 columns H and I); the Days Away, Restricted, or Transferred (DART) rate calculated as the number of days away, restricted, or transferred cases multiplied by 200,000 divided by total man hours; and the number of serious, willful, or repeat violations from OSHA citations within the last three years with required explanations. The form specifies that contractors with four serious violations, one repeat violation, or one willful violation are disqualified. Additional requirements include providing the six-digit North American Industrial Classification System (NAICS) code for the acquisition, identifying who administers the company's Safety and Health Program, and documenting the company's Insurance Experience Modification Rate (EMR) for the past three years, with a note that an EMR greater than 1.0 disqualifies the contractor. The form requires attachment of copies of OSHA 300 and 300a Forms, which are available through the OSHA publications search page.