S02 - Attachment 14 - Contractor Safety - Environmental Form.pdf

PDF 117 KB Posted

Attached to
EHRM Infrastructure Upgrades Construction - Columbia, SC VAMC Federal contract opportunity
Solicitation number
36C77623R0096
Issued by
Department of Veterans Affairs Technology Acquisition Center Austin

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This document is a contractor safety and environmental record evaluation form for solicitation 36C77623R0096 for EHRM infrastructure upgrades construction at the Columbia, South Carolina VA medical center. The form requests contact information and safety data from 2019 to the present including total man hours, OSHA recordable incidents, days away from work rates, and any serious violations. Contractors must provide an explanation for any violations received in the last three years.

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Other files for this federal contract opportunity

Other files attached to EHRM Infrastructure Upgrades Construction - Columbia, SC VAMC, newest first.
File Type Posted
36C77623R0096 0003 - Extension and RFI Answers - Columbia.pdf PDF
36C77623R0096 0001 - Columbia EHRM - Extend RFI Deadline.pdf PDF
36C77623R0096 0002 - Columbia EHRM - Site Visit Sign-In and Risk Assess.pdf PDF
544 20 107 Columbia EHRM Infrastructure Risk Assessment.pdf PDF
Columbia VA EHRM Site Visit Sign-In Sheet.pdf PDF
S02 - Solicitation - 36C77623R0096 - RFP - Columbia EHRM.pdf PDF
S02 - Attachment 3 - Columbia EHRM General Drawing Set 1 of 9.pdf PDF
S02 - Attachment 6 - Columbia EHRM Arch Drawing Set 4 of 9.pdf PDF
S02 - Attachment 9 - Columbia EHRM Mechanical Drawing Set 7 of 9.pdf PDF
S02 - Attachment 10 - Columbia EHRM Electrical Drawing Set 8 of 9.pdf PDF
S02 - Attachment 12 - EHRM Columbia VAHCS Addendum 001.pdf PDF
S02 - Attachment 1 - Columbia EHRM Statement of Work 21Feb23.pdf PDF
S02 - Attachment 2 - Columbia EHRM Specifications - 21Feb23.pdf PDF
S02 - Attachment 4 - Columbia EHRM Civil Drawing Set 2 of 9.pdf PDF
S02 - Attachment 5 - Columbia EHRM Arch Drawing Set 3 of 9.pdf PDF
S02 - Attachment 7 - Columbia EHRM Arch Drawing Set 5 of 9.pdf PDF
S02 - Attachment 16 - Wage Rates - Richland 1.6.23.pdf PDF
S02 - Attachment 13 - Limitations on Subcontracting - Construction.pdf PDF
S02 - Attachment 8 - Columbia EHRM Fire Drawing Set 6 of 9.pdf PDF
S02 - Attachment 11 - Columbia EHRM Telecom Drawing Set 9 of 9.pdf PDF
S02 - Attachment 15 - Site Visit Instructions.pdf PDF
Show all 21

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Contractor Safety and Environmental Record Evaluation Form

Information provide below is current and applicable to Solicitation 36C77623R0096

Company Name: ______________________________________________

Address: _____________________________________________________

Telephone: ______________________ Fax: ________________________

Email: _______________________________________________________

Contact: ______________________________________________________

Utilizing your OSHA 300 Forms, please complete the following information:

Category 2019 2020 2021 2022

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.

Contractor Safety and Environmental Record Evaluation Form

File details come from the government source that posted it. Updated .