S02 - Attachment 7- Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 13 KB Posted
- Solicitation number
- 36C77621R0023_1
About this file
This document contains a contractor safety and environmental record evaluation form and details of a federal contract solicitation. The evaluation form requests a contractor provide man hours, OSHA injury rates, and details of any serious violations over the past four years to be evaluated for a roof replacement project at Veterans Affairs medical facilities in Garland, Texas. The solicitation from the Department of Veterans Affairs Technology Acquisition Center Austin seeks a contractor to replace approximately 42,000 square feet of built-up roofing systems and reinsulate roofs at the Garland VAMC campus buildings by a to be determined response date to provide roofing services.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77618R0092 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2015 |
| 2016 |
| 2017 |
| 2018 |
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 .