S02_Attachment - Contractor Safety and Environmental Record Evaluation Form.docx
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- Solicitation number
- 36C26322R0046
About this file
This form requests safety and environmental records from contractors for a Department of Veterans Affairs solicitation to replace fire and isolation panels using a design-build approach. The contractor is asked to provide man hours, OSHA recordable incidents, DART rates, and any serious violations over the past three years utilizing their OSHA 300 forms. Relevant details include the solicitation number, project name and description, agency information, and a request for the contractor's safety history to evaluate their eligibility for the opportunity.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36C26322R0046 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 .