Safety footwear shall be reimbursed on employees paycheck 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your Associate Name clearly in the designated field. This ensures that your reimbursement request is correctly attributed to you.
3. Next, fill in your Associate Number and Plant/Dept. information. Accurate details help streamline the processing of your request.
4. Indicate the Date of Purchase and the Store Purchased from. This information is crucial for verifying your purchase.
5. Enter the Amount of Purchase in the specified field, ensuring it does not exceed $80 for one pair of approved safety shoes.
6. Attach the ORIGINAL receipt for the steel-toed safety shoes purchased. Confirm that it meets ANSI Z41 standards.
7. Sign and date the form in the Associate Signature section to validate your request.

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