5100.27 Receipt of PSE and Sight Con Prog Policy (1).PDF

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FRCSEINST 5103.13

FRCSE 5100/27 (Rev. 8-14) Adobe LiveCycle Designer (electronic) Adobe LiveCycle Designer (printed) All fields required Complete all required fields and mark unused optional fields with N/A.

RECEIPT OF PRESCRIPTION SAFETY EYEWEAR AND SIGHT CONSERVATION PROGRAM POLICY

1. I understand that the Prescription Safety Eyewear (PSE) that I have received this date has been principally paid for by and remains the property of the Federal Government. I further understand that this remains true despite the fact that I may have elected to obtain and personally paid for the cost of special feature(s) to be added to the eyeglasses in question.

2. I acknowledge also that my choice of special feature(s) and my having made payment from my personal funds for the option(s) for the eyeglasses which have been entrusted to me by the Federal Government was based on a decision made by me of my own free will and accord, and was made in an atmosphere completely free of coercion in any form.

3. MY ACCEPTANCE OF, PURCHASE, AND PAYMENT FOR SUCH FEATURE(S) OR OPTION(S) IN NO WAY ALTERS, ABRIDGES, OR WAIVES ANY PART OF MY OBLIGATION TO COMPLY FULLY WITH ALL ASPECTS OF THE NAVY'S AND FRCSE'S SIGHT CONSERVATION PROGRAM ADMINISTERED BY THE INTEGRATED SUPPORT DIVISION (ISD) [SAFETY] (CODE 71010).

4. Last, I agree that the feature(s) which I have selected, purchased, and paid for are solely for my personal convenience; any such purchase made by me shall not establish any property interest in the eyeglasses which conflicts with the authority of the Federal Government in making and enforcing reasonable regulations for the maintenance of a safe and healthful workplace or in matters relating to the maintenance of good order and discipline, as it shall see fit.

5. I HEREBY AFFIRM THAT I WILL:

a. Treat these glasses with care, as if I had personally paid for them

b. Make every effort to avoid damage of any type to the glasses

c. Have them repaired promptly when damage does occur so as to prevent further damage, and maintain a high level of protection for my vision.

6. I WILL NOT, UNDER ANY CIRCUMSTANCES, ATTEMPT TO REMOVE, OR CAUSE TO HAVE REMOVED THE PERMANENTLY ATTACHED SIDESHIELDS.

7. I also understand that:

a. If the lenses become scratched, they will be impartially evaluated by members of the ISD [Safety] (code 71010) for FRCSE-funded replacement using the following:

(1) As if glasses were in the custody of the evaluator (“WHAT IF THEY WERE MINE?”)

(2) As if the replacement cost was an actual out-of-pocket expense for the evaluator

(3) Consideration for the type of work I perform and its various demands.

NOTE: If FRCSE-funded lens replacement is declined, based on the above hands-on examination, I have the further option of purchasing replacement lenses meeting the requirements of ANSI Z87.1 AT MY OWN EXPENSE.

b. The PSE which has been provided to me by the Federal Government, is primarily intended for the performance of my job at the FRCSE. Although I am free to take them with me between work and home, it is expected that I have a separate, personal pair of glasses to wear while not actually working or while performing duties that are not inherently sight-hazardous. Additionally, in the event that my government-furnished PSE requires repair, I may be required to wear my personal glasses in conjunction with other vision protective devices (Plano glasses, face shields, goggles, etc.) to ensure my continued protection. It is understood that the FRCSE will freely furnish these other vision protective devices at no charge to me, as it has always done.

8. I understand that:

a. New frames for PSE are only provided on an as-needed basis. That is, safety eyeglass frames are not replaced on any sort of arbitrary schedule or simply by one's request without further justification. If lenses are to be replaced, frames will be examined and an impartial determination made by the ISD [Safety] (code 71010) as to the frames' potential for continued satisfactory service. This policy is considered to be a common-sense approach based on Item 1 of this Statement of Acknowledgement, that PSE purchased for FRCSE employees are and remain at all times the property of the Federal Government.

b. Similarly, as stated in items 5 and 7, the perspective used in making determinations for eyeglass frame replacement is based in part on that of a hypothetical “reasonable individual” faced with making the decision to reuse the old frames or to purchase new ones at their own expense. The evaluator will consider the likelihood that if an individual actually faced the choice of making the expenditure him- or herself, based on the apparent material condition of the frames, would he or she in fact be likely to make the purchase using their own money? This is felt to be a defensible starting point to help to form a rational basis for the expenditure of taxpayer-furnished Government funds.

c. If eyeglass frames appear to be genuinely usable, they will be continued in service without regard for cosmetic or style considerations alone, as eye protection at work is their primary function. Employees dissatisfied with such a determination by the ISD Safety] (code 71010) are free to purchase a set of ANSI Z87-compliant safety eyeglass frames at their own expense, if the style selected does not result in an elevated purchase price for lenses required to fit them.

9. Lost or stolen PSE will be replaced only after a completed Application for Replacement of Lost, Stolen or Destroyed Prescription Safety Eyewear, FRCSE 5100/28, is completed by the employee involved and returned to the ISD [Safety] (code 71010). Interim eye protection shall be as delineated in paragraph 7b of this document.

10. I have read, fully understand, and will abide by all of the above.

SECTION I - POLICY

SECTION II - SIGNATURE

1. SIGNEE

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