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Protect Our Frontline - PPE Request
All information is confidential and will only be used for coordination of PPE related to Protect Our Frontline / Philanthropy Worldwide. If you have questions, please reach out to
team@philanthropyworldwide.org
.
* Indicates required question
Email
*
Your email
Organization Name
*
Your answer
Organization Type
*
Hospital
Assisted Living Facility
Retail Healthcare - Pharmacy, Primary Care, Optometry, etc.
First Responder - Police, Fire, Paramedic, etc.
Grocery Store Workers
Non-profit Organization
Other:
How many frontliners are you supplying?
*
Your answer
How close are those using masks to COVID patients?
*
Within 6ft for prolonged periods of time
Within 6ft for short periods of time
Workplace with known COVID patients but no direct interaction
Interact with the general public with unknown COVID status
Other:
PPE Need Per Week
*
None
< 10
10-100
100-500
500-1,000
1000-10,000
> 10,000
N95 / KN95
Surgical Masks
Face Shields
Gowns
Gloves
Goggles
None
< 10
10-100
100-500
500-1,000
1000-10,000
> 10,000
N95 / KN95
Surgical Masks
Face Shields
Gowns
Gloves
Goggles
What is the urgency of this need and what is impact to your organization if we are unable to fulfill this request?
Your answer
Additional Details
Your answer
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