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|  DOE-HDBK-1101-2004
Exhibit 2.6.3
A
B
C
D
Comment
Safety Performance
1.
Latest year injury frequency rate
compared to average of previous
3 years.
0
7
14
20
2.
Latest year injury severity rate
compared to average of previous
3 years.
0
7
14
20
3.
The 3-year cumulative injury
frequency rate compared to
industry 3-year average.
0
10
20
30
4.
The 3-year cumulative injury
severity rate compared to
industry 3-year average.
0
10
20
30
Total Rating
__ +
__ +
__ + ___
x.60=Rating
Summary
The numerical values below are the weighted ratings calculated above. The total represents the
overall score for the subcontractor.
A.
SAFETY PROGRAM
__________
B.
EXPERIENCE FACTORS
__________
TOTAL RATING
__________%
Evaluated by: ____________________________ _________________________ ___________
Title
Date
58
|
|
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