PPE Kit Builder
Facility Name:
Name:
First Name
Last Name
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email:
example@example.com
Build Your Kit: (if you need different items, please enter them in the Comments section below.)
Rows
Number in the Kit
Size (where applicable)
Type (where applicable)
N95 Respirator
ASTM Level 3 Mask with Earloops
ASTM Level 3 Mask with Ties
Nitrile Glove, Non-Sterile
Nitrile Glove, Sterile
Goggle
Face Shield
Bouffant
Surgeon Cap
AAMI Level 3 Isolation Gown
AAMI Level 2 Surgical Gown
Coveralls
Lab Coat
Shoe Covers
Sanitizer
Alcohol Wipe Pack
Disinfectant Wipe Canister
Biohazard Bag
Disposable Stethoscope
Number of Kits Requested
Frequency of Delivery
One Time
Weekly
Monthly
Quarterly
Other
Comments:
Submit
Should be Empty: