Safety & Loss Prevention Grant Program

Program Overview

The CSD Pool now provides Safety and Loss Prevention cost reimbursement for 50% of the cost of eligible goods and educational services. Reimbursement covers any goods or services purchased by the district in an effort to improve district worker safety and to help prevent losses covered by the Pool’s various coverage forms.

Funds are available to Pool member districts after their second year of Pool participation, including both Property and Liability and Workers’ Compensation contributions.

This is a reimbursement program. A member district can obtain approval in advance with this form, but reimbursement cannot be made until the district takes delivery of Safety and LP goods or services. Copies of eligible receipts must be sent in conjunction with the submission of this electronic application.

Confirmation of available funds is available by contacting the pool administrator by phone or email.

District Pool Representatives must approve district requests for reimbursement in writing or through a confirmation email.

(*) Required Field

District *
Applicant * First Last
Phone * (### ### ####)

Email *
Purchase Info
Purchase Amount *

Date of Purchase * / MM / DD YYYY
Description of Materials or Services Purchased *

Expected Safety or Loss Prevention Outcome *
Vendor Information

Fill out this section only if your request is to pay the invoice direct to vendor, if not please skip this section.
Name of Vendor provider of materials or services
Vendor Contact First Last
Vendor Address Street Address
Address Line 2
City State Zip
Phone (### ### ####)

Email
Expected Delivery / MM / DD YYYY

Date Received / MM / DD YYYY
Invoice Number please provide the invoice number from the vendor invoice
Receipts/Invoice

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