FEMA Face Mask Request Form
ORWA has coordinated with EPA to distribute free, washable and reusable cloth (cotton) face masks provided by FEMA. These masks are available to all public water and wastewater system full-time employees, regardless of size, while supplies last. These masks will be available for pickup at various distribution points around the State of Oklahoma. Masks are limited to 10 masks per full-time water and/or wastewater employee and will be available on a first come, first served basis until the supply is depleted.

Use this form to request your free face masks and choose your preferred pick up location. Once your request has been submitted, please allow at least 1 business day for your order to be processed, then contact your chosen pick up location to schedule a pick up time.

PLEASE ONLY PLACE ONE REQUEST PER SYSTEM AND INCLUDE ALL FULL TIME EMPLOYEES FOR ALL WATER AND WASTEWATER DEPARTMENTS.

The pick up locations, along with addresses, contact info with a link to google maps, are listed here: https://docs.google.com/document/d/18WjTbEpMuiP1PF43ngX_8gGKxjG0bBYFj_cT60HUOSg/edit?usp=sharing

Multiple systems in the same area may coordinate between themselves and select an individual to pick up the masks for those systems. The individual who picks up the masks will be responsible for distributing the masks to those systems.

Each system must submit a request and list the person who will be picking up their masks.

These masks are NOT available to private or industrial systems.
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Date of Request *
Select todays date from the calendar.
MM
/
DD
/
YYYY
Utility Name *
Enter the legal name of your utility.
Utility Address *
Enter the address of your utility.
Utility PWSID or OPDES Permit Number *
Enter either your puplic water supply ID # or wastewater discharge permit #.
Utility Type *
Population Served *
Enter the population served by your utility. (Number of meters X 2.5)
Full Time Employees *
Enter the number of full-time employees of the water and or wastewater division. Include water office personnel.
Number of Masks *
Enter the number of masks requested in multiples of 5. (Maximum of 10 per Full Time Employee)
Person Making Request *
Enter your first and last name.
Phone Number *
Enter the phone number of the utility office.
Email Address *
Enter the email address of the utility.
Pickup Location *
Select your desired pickup location.
Pickup Person *
Enter the name of the person who will be picking up the masks.
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