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The document is a Safety Index Rating Form (Form C-38) from the Virginia Department of Transportation, used to evaluate a firm's safety record as part of its prequalification process. It outlines the requirements for submitting safety information, including an annual evaluation that contributes 30% to the firm's prequalification score. The form includes sections for assessing the contractor's safety philosophy and operating profile, with specific questions related to safety management practices, incident rates, and any OSHA citations. The maximum score is 300, with detailed scoring criteria provided.

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