HPU FORM | Boot Clothing Reimbursement – HPU

Hibbing Public Utilities

Boot Clothing Reimbursement

Download the PDF or Fill out online.

Boot Clothing Reimbursement

Date

Employee Name

Total Amount

$200 per year – non electrical hazard safety toe
$350 per year – electrical hazard safety

Footwear Total

AFSCME Local 94 agreement Article XVI, Section 4
$350 every two years

Clothing Total

Employee Signature

Clear Signature

Dept. Head Signature

Clear Signature

Total form Clothing

Attach all receipts to this form

Drag & Drop Files, Choose Files to Upload

Please reach out if you have
any questions or issues with the form.