Form 2146-2026

The document is a claim form for employees to report loss or damage of personal property. It outlines the necessary information required from the claimant, including job title, personal details, description of the loss, and any insurance coverage. The form must be submitted within specified timeframes depending on employee status (bargaining or non-bargaining). It also includes sections for union steward recommendations and supervisor reviews to determine the validity of the claim and potential reimbursement.

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Begin by filling out Part One, which includes your job title, name, Social Security Number (SSN), and both home and work addresses. Ensure all information is accurate and legible.
Indicate the date when the loss or damage occurred and specify the total amount of your claim. Be sure to include a detailed description of the article(s) for which you are making a claim, along with any supporting receipts or estimates for repairs.
In the section regarding insurance coverage, indicate whether you have homeowners or collision insurance and provide details about your insurance company if applicable.
Complete the certification statement at the bottom of Part One, ensuring that you understand the penalties for false claims. Sign and date this section.
If applicable, have your union steward complete Part Two and ensure they sign it. Finally, submit the form to your supervisor as outlined in Part Three.

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