S02 - Attachment 7- Contractor Safety and Environmental Record Evaluation Form.docx
DOCX document 13 KB Posted
- Attached to
- Z2DA--Renovate MOB Halls and Walls (VA-21-00007672) Garland VAMC Outpatient Clinic Garland, Texas
- Solicitation number
- 36C77621R0026
About this file
This document contains a contractor safety evaluation form and details of a federal contract opportunity for medical office building renovation services. The evaluation form requests safety-related information including man hours, OSHA recordable incidents, injury rates, and explanations for violations over the past four years. The federal contract opportunity is a Design-Build solicitation to be issued on December 23, 2020 by the Department of Veterans Affairs seeking renovation of medical office building halls and walls at the Garland VA Medical Center Outpatient Clinic. Services include demolition, casework, flooring installation, and mechanical and electrical system upgrades. The estimated value is between $2-5 million and responses are due 260 calendar days after notice to proceed. The solicitation will be set aside for Service-Disabled Veteran-Owned Small Businesses.
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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 .