Miami County, PPE Request Form

Through state, federal and private sources, Miami County has secured access to personal protective equipment available for distribution to businesses and nonprofits within the county. We are requesting that those organizations assess their own needs and determine an appropriate 90-day supply of PPE for employees and volunteers. Please complete this survey to indicate your organization's needs.

Quantities may be limited based on demand. Even if you have previously received PPE from this program, you can now place additional requests.

Please read the following prior to completing this form:

TIMING: Once an order is placed, please anticipate up to a week for the order to be prepared.

PICK-UP: Due to the large amount of supplies being provided and number of organizations being served, recipients will be asked to pick-up supplies from a distribution location in Miami County.  Information about where and when supplies can be picked up will be provided to organizations when the orders are ready.

ALLOCATION: The PPE is being provided to slow the spread of COVID-19 throughout our community and will be distributed in a manner which prioritizes public health.

UTILIZATION OF PPE: The supplies being requested through this survey must be used by the organization requesting them for the purpose of protecting employees and volunteers in the performance of their organization’s essential functions. These supplies are for use in Miami County, Kansas, and cannot be sold, nor can anyone be charged for their use. They are not intended to be provided to customers.

CONSOLIDATION OF ORDERS: To speed up the distribution for everyone, Miami County is asking organizations to consolidate orders of multiple organizations/entities whenever possible. If organizations can coordinate with like/associated groups to collectively submit a request and coordinate a single pick-up when supplies are ready, it would be greatly appreciated.

ORGANIZATIONS WITH MULTIPLE LOCATIONS: Organizations with multiple locations in Miami County will be required to consolidate orders and submit one request per organization.
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Please note: Supplies may be in a limited quantity; and orders may not be fully filled. They are meant for use by you and your employees. Not your customers.
Organization Name, Address, City *
Point of Contact Name, Title, Email, Phone *
How many employees does your organization have? (If you are consolidating request for multiple organizations or facilities, please include the total number of employees for all organizations) *
Does your organization have multiple facilities in Miami County? *
Required
Are you submitting information for multiple organizations? *
Required
Which category best describes your organization: *
Required
Please indicate the quantity your organization needs for a 90-day supply of the following items ...
Foaming Soap, 1 gallon container
Paper Towels, 600 sheet rolls
Hand Sanitizer Gel, specify 1 gallon, 8 oz or 4 oz bottles
Disinfectant Wipes, 400 per canister
Disinfectant Spray, quart bottles
Face Shields
KN-95 Masks
3-ply Disposable Masks
Surgical Mask, level 1 adult size
Surgical Mask, level 1 child size
Surgical Mask, level 3 adult size
Alginate Mask, washable adult
Alginate Mask, washable child
Cloth Masks, Hanes
Washable gowns
Disposable gowns
Gloves
Sizes include small, medium, large and extra large. Please note the quantity needed for each size
Please provide a description of how your organization is planing to use these items. *
Please provide any additional information we may need to know about your request. *
The supplies being requested through this survey will be utilized for the purpose of protecting our employees and volunteers in performing the essential functions of our organization in Miami County, Kansas. These supplies will not be sold, nor will anyone be charged for their use. *
Required
If you have follow up questions or concerns, contact MWhelan@sheriffmiamicountyks.gov or call him at (913) 294-3232 ext. 206.
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