Hard Copy Forms - Eye Safety Plus | Safety made easy and affordable

HARD COPY
FORMS

2.5/5

You will receive a stock supply of requisition forms to keep on hand. These forms are specific to your company and will come pre-printed with your company name on them. You can authorize the forms to your employees on a case by case basis.

On the reverse side of the form, it will outline the benefit criteria, letting both the employee and the dispensing office know what’s allowable and covered under your benefit plan.

The form has all the fields necessary for your employee to order a pair of Rx safety eyewear at one of our Participating ECPs.

We offer more convenient options!

Did you know we have two options that makes everything a lot easier?
Have a look at our ESP Benefit Cards and Web Ticketing Portal

HOW IT WORKS

Fill out the top half of the form, including basic employee information and any comments that may be applicable to that job.

Supply the form to the employee. They will take this form into their choice of participating optical locations. The employee must present this form to order their safety eyewear. 

The optical staff will assist the employee with selecting safety glasses. The order will be placed through our online portal. Should the final cost exceed the allowable criteria, the overage amount* will display in real time prior to finalizing the order. If the employee approves the additional cost, the optician will submit the order. 

When the glasses are ready for pickup, the optician will contact the employee. 

* For our Hard Copy Forms plan, you are responsible for collecting the outstanding costs from the employee. Your company will be billed in full. Have a look at our ESP Benefit Cards and Web Ticketing Portal plans, which directly bill the employee the overage charges so you don’t have to.

EMPLOYEE BENEFITS:

HUGE SAVINGS

Since we are the manufacturer, we can offer prices that are significantly lower than paying retail.

FAST & SECURED

Fastest turnaround and delivery time! Eyewear will generally be ready within 5-7 business days upon order.

100 day warranty

Customer satisfaction guaranteed. All of our lenses are backed with a 100 day unconditional warranty. Along with a 1 year frame defect warranty.

QUALITY MATTERS

High impact lenses with scratch resistant coating and UV protection. Certified to meet ANSI Z87.1 and CSA Z94.3.

ADD ONS available

Blue-Blocking coating and Anti-Fog coating upgrades available! Dust dam and permanent side shields when available.

get even more

FREE on-site fitting and dispensing at our location. Paper dispensing. Follow up visits. FREE promotional materials and posters.

HUGE SAVINGS

Since we are the manufacturer, we can offer prices that are significantly lower than paying retail.

FAST & SECURED

Fastest turnaround and delivery time! Eyewear will generally be ready within 5-7 business days upon order.

100 day warranty

Customer satisfaction guaranteed. All our lenses are backed with 100 day unconditional warranty. Along with 1 year frame defect warranty.

get even more

FREE on-site fitting and dispensing at our location. Paper dispensing. Follow up visits. FREE promotional materials and posters.

ADD ONS available

Blue Blocking coating and Anti-Fog coating upgrades available! Dust dam and permanent side shields when available.

QUALITY MATTERS

High impact lenses with scratch resistant coating and UV protection. Certified to meet ANSI Z87.1 and CSA Z94.3.

DOWNLOAD OUR FREE SAFETY REPORT!

Submit the form below to download 6 Things You Need to Know When Choosing A Safety Program Provider. The PDF file (8.5 MB) will be emailed to you. If you are having trouble receiving the report, please contact info@eyesafetyplus.com.

Close Menu