Pre-Award Contractor Evaluation Form

This is a Pre-Award Contractor Evaluation Form (EMR Form) that bidders/offerors must complete and submit with their proposals. The form collects essential safety and health compliance information required for federal contract evaluation purposes.

The form requires contractors to provide company identification details (name, address, telephone, fax, email, and contact person) and complete a comprehensive safety record documentation table covering four years (2022-2025). Contractors must report the number of man hours worked at jobsites and offices, number of cases involving days away from work or restricted activity, the Days Away, Restricted, or Transferred (DART) Rate calculated as the number of cases multiplied by 200,000 divided by man hours, and the number of serious, willful, or repeat violations from OSHA within the past three years with attached explanations. Disqualification criteria include four serious violations, one repeat violation, or one willful violation. Additionally, contractors must provide their six-digit North American Industrial Classification System (NAICS) code, identify who administers the company's Safety and Health Program, and disclose their Insurance Experience Modification Rate (EMR) for the past three years, with EMR values greater than 1.0 disqualifying the contractor. Contractors must attach copies of OSHA 300 and 300a Forms, which are available through the OSHA publications search page.