Attach 2 - AUTHORIZATION FOR PURCHASE OF SAFETY SHOES.PDF

DDSP FORM OST1, MAY 2016

AUTHORIZATION FOR PURCHASE OF SAFETY SHOES

The employee named below has been informed of all safety requirements regarding foot protection and is eligible to purchase safety shoes for the currently authorized amount. Section I shall be completed and signed by the employee and their immediate supervisor. Section II shall be completed by the vendor. Safety shoes purchased shall meet ASTM F2412-2413 standards.

SECTION I - AUTHORIZATION

1. EMPLOYEE NAME 2. JOB SERIES 3. LOCATION

NC MECH

4. SUPERVISOR’S NAME 5. ORG. CODE 6. PHONE NUMBER

7. CHECK ONE

INITIAL PURCHASE – Employee has been assigned to a Foot Protection Area REIMBURSEMENT – Employee has purchased safety shoes (Attach a copy of receipt) REPLACEMENT – I certify that the employee’s safety shoes are unserviceable due to (explain reason in block 10):

8. EMPLOYEE’S SIGNATURE 9. SUPERVISOR’S SIGNATURE

10. COMMENT:

11. CERTIFICATION OF LOST RECEIPT:

I recently purchased ASTM F2412-2413 standard safety shoes but have lost my receipt. In lieu of this receipt, I certify that my safety shoes were purchased at ______________________ for ___________ on __________________ (date)

SECTION II – VENDER CERTIFICATION

PLEASE NOTE: FORM IS NOT VALID UNLESS SIGNED BY BOTH THE EMPLOYEE AND SUPERVISOR.

INDIVIDUAL MUST PRESENT A VALID DLA ID AND CAC CARD AT TIME OF PURCHASE.

I hereby certify these safety shoes were purchased by the employee named above, meet the requirements of the American Society for Testing and Materials (ASTM F2412-2413) and bear the ASTM label or marking.

12. SALESPERSON PRINTED NAME 13. SALESPERSON SIGNATURE 14. DATE

10.0.2.20120224.1.869952