York County EMA COVID-19 PPE Request
For all swab/media requests: Does your facility currently have a licensed medical provider (MD, DO, NP) who can order the COVID-19 test? If no, contact your facilities medical control for further guidance
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For all swab/media requests: Does your facility currently have a licensed provider (MD, DO, NP, RN, PA, MA) who can collect the samples? If no, please contact your facilities medical control for further guidance.
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For all swab/media requests: Does your facility currently have an agreement with a commercial lab to send the samples to for analysis? If no, please contact your nearest diagnostic lab to create an account or to inquire if they can analyze COVID-19 samples.
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Nasopharyngeal (NP) swabs (boxes of 100)
Viral transport media (boxes of 72)
Your Name and Title *
Agency Name *
Telephone Number
Email Address *
Agency Type *
*Long Term Care/Home Health Only: Do you have other sources for PPE?
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N95 Masks
Number <10
10-50
50-100
100-150
150-200
Extra Small
Small
Universal
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Surgical Masks Size: Universal
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Face Shield, Size Universal
Suit, Disposable Protective
1-10
10-25
25-50
50-75
75-100
100-150
150-200
Medium
Large
2 XL
3XL
4 XL
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Gloves, Nitrile Medical (in pairs)
1-25
25-50
50-100
100-150
150-200
200-250
250-300
300-350
350-400
400-450
450-500
Small
Medium
Large
X-Large
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Gowns
1-10
10-25
25-50
50-75
75-100
100-150
150-200
Large
Extra Large
2 XL
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Other Needs
Delivery Location
Only York County locations will be accepted.
Street *
City/Town *
Does the requesting agency/facility have an active Respiratory Protection Program (RPP) in place?
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Has Fit Testing been conducted at this agency/facility within the 12 months prior to the date of this request?
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To which brand and model N95 have your employees been fit tested to?
Has the requesting agency/facility exhausted on-hand resources?
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For EMS, has your agency complete the Maine EMS PPE survey at https://forms.gle/bUEPxegEScVZ3y6i8
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For hospitals, has your agency submitted your weekly inventory to EMResource?
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