Facilities Planning & Management
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Safety Glasses

The following forms must be downloaded prior to an employee's scheduled appointment with his/her eye care provider:

The employee should have these forms available during their appointment for use or reference by the eye care provider.

The employee's supervisor should sign the eyewear order form prior to the employee's scheduled medical appointment. The eye care provider must complete the bottom half of the order form beginning with the patient's name and ending with the signature lines. The order form must be returned to FP&M by the employee after the prescription information is completed so we can submit it.

Employees may see the eye care provider of their choice.

If you have any questions about procedures or costs relating to safety glasses, please call Joe Kolosso at Facilities Planning and Management at 472-5545 or 472-1320.