Personal Protective Equipment and Critical Supplies Needed for COVID-19 Response
What is your organization? *
Your answer
What is your name? *
Your answer
What is your email? *
Your answer
What is your phone number? *
Your answer
What is your address? *
Your answer
What is your sector? *
What quantity do you have of eye protection and goggles? *
Is your eye protection in the original shipping packaging? *
What quantity do you have of face shields? *
Are your face shields in the original shipping packaging? *
What quantity do you have of surgical masks - with shields? *
Are your masks in the original shipping packaging? *
What quantity do you have of surgical masks - without shields? *
Are your masks in the original shipping packaging? *
What quantity do you have of N95 masks? *
Are your masks in the original shipping packaging? *
What quantity do you have of non-sterile gloves? *
Are your gloves in the original shipping packaging? *
What quantity do you have of sterile gloves? *
Are your gloves in the original shipping packaging? *
What quantity do you have of disposable gowns? *
Are your gowns in the original shipping packaging? *
What quantity do you have of biohazard bags? *
Are your bags in the original shipping packaging? *
What quantity do you have of anesthesia machines? *
What quantity do you have of ventilators? *
Do you have other PPE or emergency supplies not listed on this form? If so, can you describe it, and list the quantity? *
Your answer
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