Mask Request for Health Care Workers- Chicagoland and Western Suburbs
Please use this form to request a mask for you and/or co-workers. A mask maker will contact you to arrange porch pick-up. Please note the following:
- Please provide proof of your credentials and place of employment to
- Requests for 20+ masks require documentation from a supervisor who can confirm the need.
- These masks are lined with a non-woven material, they are not as effective as N95 masks but they are something in this time of crisis and can fit over an N95. Our hope is that these will all eventually end up in the trash when proper PPE arrives.
First and Last
City of residence
Are you a health care worker
What are your credentials and current place of employment (e.g., RN at ABC Department, XYZ Hospital)
You MUST include your credentials and place of work. All requests will be verified via IDPH or Linked-In. To expedite the process, please send proof of your credentials and place of employment to
. Requests for 20+ masks require documentation from a supervisor who can confirm the need.
How Many Masks are you requesting
Please feel free to request additional for your hospital floor - Please indicate that in your answer. We will do our best to support you
Do you prefer Adult - Elastic; Adult - Ties, or Child masks? (we will try to meet this request if possible)
Adult - Elastic
Adult - Ties
Adult - it doesn't matter what kind
Other (describe below)
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