Returning to Site - Supplies Needed
Please provide as much lead time as possible due to supply availability.
Academic School or Department, Requester Name, Phone Number and Email Address
Laboratory Name (If Applicable)
Name of Building Manager or Assistant Dean, Phone Number and Email Address
Name of PI or Faculty Member in Charge, Phone Number
Location Where Supplies Will Be Used (Building and Room Number)
Number of Employees Returning
Items Needed (Check All Boxes That Apply)
Hand sanitizer pump bottles. Please include conference rooms and study rooms in your count
Disposable Vinyl Gloves (for use with disinfectant spray)
Face Coverings (washable)
Reusable face shield (to be worn with face covering)
Disinfectant Wipes (for limited use in areas with shared computers and equipment)
Do you or anyone in your unit have a latex allergy?
Size of Disposable Vinyl Gloves Preferred
M and XL
Anticipated Return date
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