Attachment 5: Safety or Environment
Updated
A PDF document (233 KB) attached to FY27 NRM (PROJ 573-24-110) BB - Expand Cardiology Service, from the Department of Veterans Affairs. Due Oct 28, 2026, 3:30 PM (UTC-4).
File name: Attachment 05 - Safety or Environment.pdf
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Solicitation Attachment
Safety or Environmental Violations and Experience Modification Rate
Pre-Award Contractor Safety and Environmental Record Evaluation Form 1. Utilizing your OSHA 300 Forms, please complete the following information: Category
2023
2024
2025
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. Please attach copies of the following documents: OSHA 300 and 300a Forms. These forms can be accessed through the OSHA publications search page:
http://www.osha.gov/pls/publications/publication.html.
2. Provide your six-digit North American Industrial Classification System (NAICS) Code for this 3. Who administers your company’s Safety and Health Program?
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