Safety Glasses Approval Form
Understanding this form
The Safety Glasses Approval Form is a document that allows an immediate supervisor to authorize the purchase of safety glasses for an employee. This form is essential for ensuring that employees who require prescription safety glasses can obtain them while also enabling reimbursement for the associated costs. It is distinct from other safety equipment forms as it specifically pertains to prescription eyewear.
What’s included in this form
- Employee name and department: Identify the employee who requires safety glasses.
- Extension and account number: Provide necessary contact information and departmental accounting details.
- Reimbursement amounts: Specify the amounts for single vision, bifocal, and trifocal glasses.
- Supervisor approval: Signature and date fields for the supervisor to validate the request.
When to use this form
This form should be used in any situation where an employee needs prescription safety glasses for their job and is eligible for reimbursement. It is particularly relevant in industries where eye safety is paramount, and employees require corrective lenses to perform their duties safely and effectively. Supervisors should complete this form whenever an employee requests approval for such glasses.
Who this form is for
- Supervisors overseeing employees who require prescription safety glasses.
- Employees needing safety glasses for health and safety compliance.
- Human resources personnel handling reimbursement processes for safety equipment.
Steps to complete this form
- Enter the employee's name, extension, and department at the top of the form.
- Fill in the account number relevant to the employee's department for billing purposes.
- Specify the reimbursement amounts for single vision, bifocal, and trifocal glasses.
- The supervisor must review and check the appropriate approval box for the request.
- Sign and date the form to formally approve the request.
Notarization requirements for this form
This form does not typically require notarization unless specified by local law. Always check with your employer or legal advisor for specific requirements in your area.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Avoid these common issues
- Failing to specify the correct reimbursement amounts for the different types of glasses.
- Not including the employee's full name or department, which can delay processing.
- Neglecting to obtain the supervisor's signature and date, making the form invalid.
Benefits of using this form online
- Convenience of instant download and easy access for supervisors and employees.
- Editable format allows customization to fit specific workplace needs.
- Reliable templates drafted by licensed attorneys ensure compliance with legal standards.
Quick recap
- The Safety Glasses Approval Form is essential for obtaining and reimbursing prescription eyewear for employees.
- Accurate completion of the form is crucial to ensure timely approvals and reimbursements.
- It is a straightforward document that benefits both supervisors and employees in maintaining workplace safety.
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FAQ
To help minimize the risk of workplace injury, OSHA requires the use of personal protective equipment, or PPE. Under OSHA laws, employers may be responsible for providing prescription safety glasses to employees.
A: OSHA's eye and face protection standard, 29 CFR 1910.133, requires the use of eye and face protection when workers are exposed to eye or face hazards such as flying objects, molten metal, liquid chemicals, acids or caustic liquids, chemical gases or vapors, or potentially injurious light radiation.
Every employer shall ensure that suitable personal protective equipment is provided to his employees who may be exposed to a risk to their health or safety while at work except where and to the extent that such risk has been adequately controlled by other means which are equally or more effective.
All OSHA-approved safety glasses must have markings specified by the American National Standards Institute's ANSI Z87. 1-2010 standard on both the lenses and the frame of the eyewear piece. If the lenses are Impact Rated, they also should have the manufacturer's mark, followed by a "+" sign.
Employers must provide and pay for non-prescription safety eyewear. Employers are not required to pay for prescription safety eyewear. Workers who prefer wearing prescription safety eyewear may have to pay for it themselves. Remember: Safety eyewear can't protect you unless you wear it.
According too OSHA, those additional labels include: z87+: z87 means the glasses have been tested for regular impact, while z87+ means they've been tested for high-impact. D3 and D4: D3 means the glasses have been tested to resist chemical droplets, while D4 means they've been tested for a full splash.
Are Employers Obliged to Offer Prescription Safety Glasses? There are Employment Law guidelines regarding eye tests and the potential of payment for glasses, however, there is no legal guidance for prescription protection goggles.
Ultimately, under OSHA standards, employers may not be responsible for providing funding for prescription safety glasses. Let's start with the bad news. While employers must pay for their employees' PPE to comply with their OSHA requirements, there are several payment exceptions under the OSHA rule.
You may encounter safety eyewear with only Z87 or the manufacturer's mark with a + stamped on the lens or frame. These products, produced before or just after the 2010 standard, are still safe to use. They still meet ANSI Z87.
