Prescription Safety Glasses Reimbursement Form

• Home
• Employee Portal
• Prescription Safety Glasses Reimbursement Form

Prescription Safety Glasses Reimbursement Form

This form is valid towards the purchase of prescription safety glasses to be worn during work. The reimbursement amount is $175. The employee is responsible for any costs exceeding $175.

Please fill out this form and attach receipt(s) in the designated field.