S02 - ATTACHMENT 7 - Contractor Safety - Environmental Form.docx
DOCX document 14 KB Posted
- Attached to
- Y1DZ--EHRM Training and Admin Space Construction - Fargo, ND Federal contract opportunity
- Solicitation number
- 36C77622B0019
About this file
This is an evaluation form for contractor safety and environmental records related to solicitation 36C77622B0019 for the construction of an EHRM training and administrative space in Fargo, North Dakota. The form requests the company name, address, telephone, fax, email, and contact information. It also requires contractors to provide their OSHA 300 form data for the last four years, including the number of man hours, number of cases involving days away from work or restricted activity, days away restricted or transferred rate, and any serious, willful, or repeat OSHA violations in the last three years along with an explanation for any violations.
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Other files for this federal contract opportunity
| File | Type | Posted |
|---|---|---|
| ATTACHMENT 2 - Drawings Updated 4.26.22.pdf | ||
| Price Cost Schedule.pdf | ||
| Technical Questions - Fargo response - 4-27-22.pdf | ||
| ATTACHMENT 1 - Specifications Updated 4.26.22.pdf | ||
| 36C77622B0019 0002.docx | DOCX document | |
| 36C77622B0019 0001.docx | DOCX document | |
| Attachment 1 Sign in Sheet Training Space Fargo.pdf | ||
| S02 - ATTACHMENT 6 - Wage Rates - Cass County - 2-28-22.pdf | ||
| S02 - ATTACHMENT 4 - COVID-19 Safety Protocols 12-14-21.pdf | ||
| S02 - ATTACHMENT 3 - Contractor Core Work Hours.pdf | ||
| S02 - ATTACHMENT 5 - Limitations on Subcontracting - Construction.docx | DOCX document | |
| S02 - ATTACHMENT 1 - Specifications.pdf | ||
| S02 - ATTACHMENT 2 - Drawings.pdf | ||
| 36C77622B0019_1.docx | DOCX document |
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Text version
Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C77622B0019 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2018 |
| 2019 |
| 2020 |
| 2021 |
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 .