CLICK SAFETY - OSHA30 Reimbursement Request Form
I have successfully completed Click Safety OSHA30 Online Training. I have presented the OSHA30 Card and payment receipt to the S.E.T. Fund for reimbursement to me, or my employer, for the cost. By signing this form, I acknowledge receipt of such reimbursement to myself, or my emplyer, in the amount indicated.
Name
*
First Name
Last Name
Email Address
*
Member Book Number
*
Phone Number
*
Last 4 of Social Security Number
*
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Required Documents:
Please upload your RECEIPT(s)
Please upload the FRONT of your MEMBER BOOK
Please upload the BACK of your MEMBER BOOK
Please upload the CERTIFICATE OF COMPLETION
Submit
Should be Empty: