BHE Contractor Submission Form

Please complete the fields below. All fields except “Notes” are required.

"*" indicates required fields

Business*

Subscription Type*

Full Verification Package – Ongoing review of contractor safety records for a specific contractor; certificates of insurance (COIs) optionally included without extra charge. Pricing based on Contractor’s number of employees as verified on the OSHA 300 log

Standalone Certificate of Insurance – Ongoing service applicable when a Verification Package is not appropriate, e.g. not safety-sensitive

Prequal Full – One-time review of records included in the Verification Package in support of BHE competitive bids; bid winner will be directed to purchase Verification Package

Prequal Light – One-time review and scoring of the following records: 3 most recent years of OSHA Total Recordable Injury Rate (TRIR), TRIR 3-year average and Fatalities. Applicable to Contractors who are not safety-sensitive and do not have need of Verification Package

Contractor Information

Company Name*

Contact Name*

First Last

Email Address*

Phone Number*

Will contractor perform DOT covered tasks? (note: by selecting this option, we’ll also require an OQ Subscription)*

Yes

Notes

Requested by*

First Name Last Name

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Department

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