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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 *
  • Contact Person's Phone Contact Person's Phone * - -
  • 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

    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.

  • Sanitizer

    All sanitizers that are requested through this form are at least 60 percent alcohol based which is recommended by the CDC

  • Disinfectant Wipes

    The disinfectant that will be used is an EPA-and DEC-registered labeled to be effective against rhinovirus and/or human coronavirus.

  • Disinfectant Spray

    The disinfectant that will be used is an EPA-and DEC-registered labeled to be effective against rhinovirus and/or human coronavirus.

  • 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. .

  • Disposable Masks, Face Shield, N95

  • 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 *
  • 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.

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