North Coast California Mask Brigade Donor and Volunteer Form

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Many hospitals are already running desperately low on supplies of filtering facepiece respirators (commonly known as "N-95 masks") and other kinds of personal protective equipment (PPE), and the need is only expected to increase going forward.

Healthcare workers are on the front lines of the fight against the new coronavirus, and they urgently need this equipment to stay safe while they work to care for our community.

Many of us have a personal stock of respirators and other PPE. You may have bought these to protect yourself from wildfire smoke, for use during a DIY project, or recently before it became clear that PPE was in short supply where they are needed most (healthcare facilities).

We are a group of volunteers working to coordinate collection of donated items and delivery of this essential equipment to local healthcare facilities in Trinity, Humboldt, and Mendocino counties. Volunteer drivers will pick up equipment from donors and deliver it directly to local hospitals and clinics.

If you have respirators (or other forms of PPE) that you are able to donate, please complete the form below. Someone will get in touch with you to organize a pickup (to ensure safety, we will ask you to leave the respirators outside your door at a pre-arranged time).

Note: Some healthcare facilities are only able to accept respirators in unopened packages. If you have unused respirators but in opened packages, we will still work to find a facility who can use them. Please make sure to specify the condition of your donated items.

If you would like to volunteer to pick-up or organize PPE, please fill out this form: https://forms.gle/Cr1JB8Rh1VdC59Zh7

If you represent a healthcare facility in need of PPE, please fill out this form: https://forms.gle/LHXLVS1SGj2739oB8

Information about Respirator Masks

The image below shows an example of what an N-95-style respirator looks like (the ones you have might look different). Respirators in this class may contain one of the following labels:
- N95
- Surgical N95
- N99
- N100
- R95
- P95
- P99
- P100
- FFP2
- FFP3
- KN95

If you're unsure about what you have and whether it is okay to donate, send us an email and we will try to help.

Example photos of N-95 respirators

How many masks can you donate? *

What is the condition of your masks? *

Unopened box or unopened individually packaged masks.

Open box or no box (masks not individually packaged/sealed).

Both opened and unopened (please describe the quantities in each condition in the "Anything else we should know" box at the bottom of this form).

Unsure (please describe the condition of the masks in the "Anything else we should know" box at the bottom of this form)

Do you have other PPE you can donate? *

Nitrile gloves

Eye protection (safety glasses, face shields, etc)

Surgical masks

Hand sanitizer

Disinfecting wipes

Gowns

Other:

Required

Preferred method of contact (be sure to enter appropriate corresponding info below) *

Text message

Phone call

Name *

Phone number

Pickup Location (region, please select one) *

Trinity County

Northern Humboldt County

Southern Humboldt County

Coastal Mendocino County

Inland Mendocino County

Pickup Location (street and address, please include apartment number) *

Pickup Location (city) *

Pickup Location (zip code) *

Anything else we should know?

Submit

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