Request for PPE, Disinfectant and Sanitizer Refill

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Request for PPE, Disinfectant and Sanitizer Refill

This form is used to request Personal Protective Equipment, Disinfectant and Sanitizing Supplies during Covid-19.

This form is for Departmental needs.

ALL PUBLIC SPACES SUCH AS CLASSROOMS AND LABS WILL BE HANDLED BY FACILITIES

This request will be processed in accordance to campus guidelines for sanitation. You will be contacted for further information, on the decision and delivery details.

All requests submitted for approval to EHS and/or Facilities.
Campus Address you would like supplies to be delivered
Contact Person Contact Person * First Last
Contact Person's Phone Contact Person's Phone * - ### - ### ####
Contact Person's e-mail *
Department *
Building *
Room Number for items to be delivered *
Any additional delivery instructions
Items being Requested

All costs of supplies will be processed through a central account held for COVID-19 related purchases. Departments at this time will not have to supply an account number for journal transfer.
What do you need to order?
you can select more than one option

What do you need to order?
you can select more than one option Sanitizer, Disinfectant, Gloves, Wipes Disposable Masks, Face Shield, N95

Please select for this list, you may select more than one option.
Sanitizer, Disinfectant, Gloves
Department Kits

Please select below any replacement kits you would like. These kits are ordered in full, if you need less then full quantities please select from other selections below.

When we deliver these kits, we will pick up any empty containers that you might have, so that we can sanitize and reuse them.
Full Kits:
Each Kit Contains:
11 - 8oz-12oz Sanitizing Hand Spray
10 - Small Containers of Hand Wipes
10 - 2oz Sanitizing Hand Spray
1 - Large Container of Hand Wipes

Please choose the quantity of Full Kits you need
Half Kits:
Each Kit Contains:
5 - 8oz-12oz Sanitizing Hand Spray
5 - Small Containers of Hand Wipes
5 - 2oz Sanitizing Hand Spray
1 - Large Container of Hand Wipes

Please choose the quantity of Half Kits you need
Sanitizer

All sanitizers that are requested through this form are at least 60 percent alcohol based which is recommended by the CDC
Quantity of Hand Sanitizer(s) 2 OZ

Please choose the quantity of 2oz Hand sanitizer you need
Quantity of Hand Sanitizer(s) 8OZ-12 OZ

Please choose the quantity of 8oz-12oz Hand sanitizer you need
Quantity of NY Clean Sanitizing Spray 16 OZ Size NY Clean should not be used on Painted surfaces

Please choose the quantity of 16oz of NY Clean Sanitizing Spray you need
Quantity of NY Clean Sanitizing Spray 1 Gallon Size (This is for areas that are approved to have NY Clean in Gallon size. This order will be reviewed when placed. This is used for refilling purposes only)

Please choose the quantity of 1 gallon of NY Clean Sanitizing Liquid you need for refilling 16 OZ bottles
Disinfectant Wipes

The disinfectant that will be used is an EPA-and DEC-registered labeled to be effective against rhinovirus and/or human coronavirus.
Quantity of Small container(s) of Disinfectant Wipes

Please choose the quantity of Small containers of Disinfectant Wipes you need. These containers have approximately 20-60 wipes per container.
Quantity of Large container(s) of Disinfectant Wipes

Please choose the quantity of Large containers of Disinfectant Wipes you need. These containers have approximately 110-160 wipes per container.
Quantity of Blue Top Disinfecting Wipes (This is for areas that are approved to use these types of wipes. This order will be reviewed when placed.

Please choose the quantity of wipes needed
Disinfectant Spray

The disinfectant that will be used is an EPA-and DEC-registered labeled to be effective against rhinovirus and/or human coronavirus.
Quantity of Disinfectant Spray 32 OZ Size (Each bottle will be delivered with 2 microfiber cloths, you will also need to select 1 box of gloves below in the size of the user. NY Clean should not be used on Painted surfaces)

Please choose the quantity of 32oz of Disinfectant Spray you need
Please describe the details for your request of disinfectant spray - This will only be distributed on a case by case basis.

Please give as much detail as possible including reason for the request.
Gloves ( Each box contains 90 to 100 gloves per Box)

All gloves are Latex free and made from Nitrile. .
Quantity of Small

Please choose the quantity boxes needed
Quantity of Medium

Please choose the quantity boxes needed
Quantity of Large

Please choose the quantity boxes needed
Quantity of Extra Large

Please choose the quantity boxes needed
Please describe the details for your request of Gloves

Please give as much detail as possible including reason for the request.
Disposable Masks, Face Shield, N95
Quantity of Disposable Masks ( Packs of 50 ) if you need singles please call the Facilities Service Center at
585-395-2408

Please choose the quantity of Disposable Masks you need
Quantity of True Hero Face Shields

Please choose the quantity of Face Shields you need
Please list who the shields are for and why
Quantity of ADA Clear Disposable Face Masks

These are for ADA use only please select the quantity needed.
Quantity of N 95 Masks

Please choose the quantity of Approved N95 Masks you need (You must be fit tested to wear - Please contact EHS before ordering)
Quantity of N 95 Small Masks

Please choose the quantity of Approved N95 small Masks you need (You must be fit tested to wear - Please contact EHS before ordering)
Please describe the details for your request of N95 masks

Please give as much detail as possible including reason for the request.
Gowns and Thermometers
Quantity of Approved Gowns ( Packs of 50)

Please choose the quantity of Approved Gowns in cases of 50 you need (You must be an approved department for this)
Quantity of Thermometers

Please choose the quantity of Thermometers you need
Please describe the details for your request of Thermometers

Please give as much detail as possible including reason for the request.
Different Items needed that are not listed in this form
( This section is only for items not listed in section "Items being requested" above. Please check boxes in that section to see all products available. )

If your department needs other items that are related to Personal Protective Equipment, disinfecting or sanitizing please follow the link below to a separate form to request items needed.

EHS and Facilities will contact you to discuss your request.

Click Here to Submit a Request for additional Items
Authorization

Please enter the name and e-mail of the person in Charge of the department that is authorizing this request.
Name of Person in Charge of Department Name of Person in Charge of Department * First Last
Email Person in Charge of Department *
Please enter the Account number to be charged
Submit for Authorization

Please click the box below to send this form to the Head of your Department for approval. You will enter their email address the same as the one above.
If You are the department head please just hit continue to finish this process.
Save my progress and resume later
Enter Your Email Address *

A unique link to resume this form will be sent to the email address entered here.

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Main Page Content

Request for PPE, Disinfectant and Sanitizer Refill

Campus Address you would like supplies to be delivered

Items being Requested

All costs of supplies will be processed through a central account held for COVID-19 related purchases. Departments at this time will not have to supply an account number for journal transfer.

Sanitizer, Disinfectant, Gloves

Department Kits

Sanitizer

Disinfectant Wipes

Disinfectant Spray

Gloves ( Each box contains 90 to 100 gloves per Box)

Disposable Masks, Face Shield, N95

Gowns and Thermometers

Different Items needed that are not listed in this form
( This section is only for items not listed in section "Items being requested" above. Please check boxes in that section to see all products available. )

Authorization

Submit for Authorization

Main Page Content

Request for PPE, Disinfectant and Sanitizer Refill

Campus Address you would like supplies to be delivered

Items being RequestedAll costs of supplies will be processed through a central account held for COVID-19 related purchases. Departments at this time will not have to supply an account number for journal transfer.

Sanitizer, Disinfectant, Gloves

Department Kits

Sanitizer

Disinfectant Wipes

Disinfectant Spray

Gloves ( Each box contains 90 to 100 gloves per Box)

Disposable Masks, Face Shield, N95

Gowns and Thermometers

Different Items needed that are not listed in this form ( This section is only for items not listed in section "Items being requested" above. Please check boxes in that section to see all products available. )

Authorization

Submit for Authorization

Items being Requested

All costs of supplies will be processed through a central account held for COVID-19 related purchases. Departments at this time will not have to supply an account number for journal transfer.

Different Items needed that are not listed in this form
( This section is only for items not listed in section "Items being requested" above. Please check boxes in that section to see all products available. )