PPE Request Sign-Up
In collaboration with the Keck Medicine with USC, we developed disposable and reusable face shields and reusable N95-like masks for use by health care professionals.  We have different sizes.  These are produced using a combination of 3D printing, laser cutting, and manual finishing.  Keck’s Respiratory Support and Infection Prevention staff worked alongside designers, engineers, and fabricators to develop these final designs.  We are also looking into printing nasopharyngeal swabs for collecting patient samples for COVID-19 testing.  If your facility is experiencing a shortage of PPE or other supplies and can accept these in their place, please sign up to request a donation of our items.  We are currently only able to deliver in Southern California.  Your facility need not be affiliated with USC.
Sign in to Google to save your progress. Learn more
Name
Email Address
Phone Number
Organization / Affiliation
Type(s) of PPE needed
Is there a specific model(s) preferred for PPE?
Amount of PPEs needed -- separate answers with commas
Location / Address
Comments
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of University of Southern California. Report Abuse
Google Forms