Nursing Home Survey

The purpose of this survey is to gather information from Wisconsin's skilled living nursing facilities to create a group purchasing arrangement to drive down the pricing on all PPE but especially isolation gowns. Filling out this survey will give you access to Magid Glove & Safety Manufacturing, one of the nation's largest safety manufacturing and distribution companies who has been in business for over 70 years, offering quality products at a competitive price.

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* 1. Facility Name

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* 2. Facility PPE Contact

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* 3. Title

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* 4. Address

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* 5. Phone

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* 6. E-mail

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* 7. Number of Disposable 3-Ply Face Masks Needed Monthly

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* 8. Number of N95 Respirators Needed Monthly

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* 9. Number of Disposable Isolation Gowns Needed Monthly

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* 10. Number of Re-Usable Isolation Gowns Needed Monthly