Need for Personal Protective Equipment Survey

HSC has been asked to assess the demand for Personal Protective Equipment (PPE) in the social services sector. This survey will help us get a sense of the need in the sector.

1. Contact Information *This question is required.

First Name

Last Name

Title

Company Name

Email Address

Phone Number

2. Does your organization need Personal Protective Equipment?

3. Please let us know specficially what you need and in what quantity. Examples of PPE include:

N95 Respirator Masks: NIOSH certified,with NIOSH approval number; CDC-approved model; Fluid-resistant (https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/n95list1.html)
Facemasks: 3-ply; Non-woven fabrics
Surgical Masks: Fluid resistant; Non-woven fabric; BFE (Bacterial Filtration Efficiency) of at least 99%
Isolation Gowns
Gloves

N95 Respirator Masks
Facemasks
Surgical Masks
Isolation Gowns
Gloves

3. How urgent is your need?

3. Are you interested in negotiating group purchasing prices? (The plan would be that, once there is an agreed-upon price, the organization would then itself pay that price to the PPE vendor when ordering.)

4. If so, what items (gloves, or other PPE and for whom (e.g., workers and/or constituents)?