S02 - Attachment 9 - Contractor Safety and Environmental Record Form.docx

DOCX document 24 KB Posted

Attached to
EHRM San Antonio Infrastructure Upgrades Construction (SDVOSB Set-Aside and 236220 NAICS)
Solicitation number
36C77623B0064
Issued by

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This document contains an attachment to a solicitation requesting safety and environmental records from bidders. The solicitation is for the EHRM San Antonio Infrastructure Upgrades Construction opportunity issued by the Department of Veterans Affairs Technology Acquisition Center Austin. Bidders are required to provide company information, man hours, OSHA recordable incidents, days away from work rates, and details of any serious OSHA violations from the past three years on the attachment form using their OSHA 300 records. The opportunity is set aside for service-disabled veteran-owned small businesses and has a NAICS code of 236220.

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ATTACHMENT 9 - Contractor Safety and Environmental Record Evaluation Form

Information provided below is current and applicable to Solicitation 36C77623B0064. Please include this completed form in your bid or proposal.

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.

ATTACHMENT 9 TO SOLICITATION 36C77623B0064 EHRM SAN ANTONIO INFRASTRUCTURE UPGRADES

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