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DocuSign Envelope ID:2C304718-BA25-4043-9BDC-F17B3EF664D8 <br /> Contractor's Safety Record Information <br /> The Contractor's safety record shall be reviewed and eValUated in addition to other quality and <br /> performance criteria as part of bid evaluation process. FailUrc to provide the requested <br /> inforination arid documentation may result in rejection ofyour bid as non-responsive, <br /> Accordingly, all bidders niust submit the following infum-i ation regarding their safety record. <br /> The following definitions shall apply to this section: <br /> 0 <br /> "DAwr incident rate"- Acronym for"Days Away, restrictions and Transfers". The <br /> DART' incident rate may be used to show the relative level ofinjurieS and illnesses within <br /> a firin,cornpared to the industry, It is based only on those injuries and illnesses severe <br /> enough to warrant "Days Away, ReSLYICtionS and Transfers". The DART Incident rate is <br /> calculated using OSHA's Forin 300 and the following forniula: <br /> ((Nurnber of entries in column H (days away from Nvork) + column I Oob transfer or <br /> restriction)x 200,000) /(Number of hours worked by all employees) = DART Incident <br /> rate. <br /> "EMR---Acronym for"Experience Modification Rate." is an indicator of a contractor's <br /> past safety pert arrnar[ice, widely used by the insurance industry as an equitable means of <br /> detenninino premiums for workers' corripensanon insurance. The rating systern considers <br /> the average workers' compensation losses for a given firm's type of work and arnount of' <br /> payroll and predicts the dollar arnount of expected losses to be paid by that employer in a <br /> designated rating period. LIMIally three years, The rating is based on comparison of firms <br /> doing.(;inrilar types of work, and the employer is railed against the average expected <br /> perforniancc in each work classification. LOSSCS ilICUT-red by the ernployer for the rating <br /> period are then cornpared to the expected losses to develop an experience rating, <br /> "0S-HA"- Acronym for the Federal Occupational Health and Safety AdrnnliStTatiolL <br /> The term "OSHA" as Used in this Policy also refers to any state or local agency having <br /> jurisdictional authorization to enforce worker safety requirements and assess lines or <br /> warnings for violation of Nvarker safety standards. <br /> 1. QSRA DART incident Rate, Provide the bidder's DART Incident Rate <br /> calculated from OSHA's Iorin 300 for the last three years and the other required <br /> information shown ill the example table below. The bidder inust aaach all sul)I)orling <br /> documentation and c-alculations includino,cerii ed 0SHA'ibrms. <br /> C fi <br />