S02 - Attachment E - Contractor Safety and Environmental Record Evaluation Form.docx
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- Solicitation number
- 36C77621R0003
About this file
This document provides details for a federal contract opportunity to design and construct a Pharmacy USP 800 facility at the Veterans Affairs North Texas Health Care System in Dallas, Texas. The Department of Veterans Affairs intends to solicit proposals for a single, firm-fixed-price design-build contract. The project scope involves modifying the Pharmacy Area to meet USP 800 and 797 compounding standards and includes architectural, structural, electrical, mechanical and fire protection system design. Proposals will be solicited as a total Service-Disabled Veteran-Owned Small Business set-aside, with a NAICS code of 236220 and size standard of $39.5 million. The period of performance is approximately 180 calendar days from notice to proceed, with a construction magnitude estimated between $1,000,000 to $2,000,000. The solicitation is scheduled for release on or about October 23, 2020.
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Contractor Safety and Environmental Record Evaluation Form
Information provide below is current and applicable to Solicitation 36E77620R0013 Company Name: ______________________________________________ Address: _____________________________________________________ Telephone: ______________________ Fax: ________________________ Email: _______________________________________________________ Contact: ______________________________________________________ Utilizing your OSHA 300 Forms, please complete the following information:
| Category |
| 2016 |
| 2017 |
| 2018 |
| 2019 |
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 .