COVID-19 Critical Supplies Survey

Is your company able to assist in the production of critical supplies?

Our nation is needing manufacturers who can provide and/or produce large-scale quantities of critical supplies to help respond to the COVID-19 pandemic.

Please complete this brief survey about your production ability. Due to the urgency of the request for information, we are attempting to receive responses ASAP.

Question Title

* Contact Information:

Name

Title

Company

Address

City

State

Zip Code

Phone

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* Which of the following supplies can you provide and/or produce? (Check all that apply.)

Cotton swabs with long wooden sticks

Endotracheal tubes (assorted sizes)

Falcon tubes

Gloves (all sizes)

Lightweight protective suits

N95 masks

Over-the-shoe booties

PAPRs

Rapid PCR test kits

Ventilators, specifically Positive End Expiratory Pressure (PEEP) ventilators

Vital sign monitors

Viral transport media

Other (please specify)

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* For each supply checked, please specify the product model number and include the quantity.

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* For each supply checked, please include the city and state of the facility that would produce and/or provide the supply.

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* Are there any supplies or other provisions that you could donate to the nation’s COVID-19 pandemic response?

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* Who should be the point of contact for any follow-up requests from the Administration?

Name

Title

Company

Address

City

State

Zip Code

Phone