Alameda County COVID -19 Resource Request Form

UPDATED MAY 22, 2020

This form should be used by Alameda County organizations that are requesting resources that specifically relating to the COVID-19 incident. This includes medical supplies such as Personal Protective Equipment (PPE), etc. Please continue to check in with your vendors and source new vendors to be able to procure supplies independently. Resource request should only be submitted when your organization is unable to procure supplies elsewhere. This is not for use by the general public.

Organizations located outside of Alameda County should contact their City or County Emergency Operations Center(s) to determine their process. Out of county resource requests will not be filled.

Additionally, we will NOT be filling any requests for household items such as soap, bleach, toilet paper, paper towels, tissues, garbage bags, etc.

This form is to be filled out completely and with enough detail that a non-medical logistics person would know EXACTLY what, and how much is needed. Please be as specific as possible. Indicate if a generic or similar product might suffice. This also assumes that there is an immediate need (not projected) and ALL avenues to procure material have been fully exhausted.

Please list only one item (i.e. N95 masks, face shields, gown) per "Request Detail" section. If you need more than one item, click "Yes" to the "Do you have additional resource requests?" question at the end of each "Request Detail" section and another page will be generated where you can list additional items that are needed.

Quantities. As all of the supplies that we have come in variety of units of measure, please list the total / whole number or requested item. For instance, when you want 500 procedure masks, instead of requesting 5 boxes of procedure masks, please request 500 procedure masks. If you are requesting gloves, please list what size(s) you are requesting. If you are unsure of how many of an item to request, estimate how many of that item you would need to hold you over until your regular supply chain is able to deliver and/or 2-4 weeks of supplies.
Email address *
Where are you located? *
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy