Healthcare Providers SC COVID-19 Healthcare Survey If you need immediate assistance, please email cspangler@scmep.org. Question Title * 1. Point of Contact Name Company Job Title Address City/Town State/Province ZIP/Postal Code Email Address Phone Number Question Title * 2. We are in need of the following supplies and/or equipment. [Please indicate quantity desired beside each] Note: Any additional detail related to items may be noted in the Comments/Notes field below. Alcohol Pads Biohazard Waste Bags - red, 10 gal, 24" or similar in size Bleach Boot Covers Cleaning Solution Spray - Vionex, Cavicide or similar Cleaning Supplies Comfort Strips Coveralls Digital thermometers (forehead) Disinfectant Spray Disposable stethoscopes Disposable Thermometers Face Masks Face shields Facial Tissues Gloves, Exam, All Sizes Goggles Goggles - antifog, splash/impact-resistant, Condor, similar to Grainger #1VT70 Gowns, Disposable, All Sizes - ISO rated, surgical gowns, impermeable, polypropylene, 3-layer Hand Sanitizer Hand Soap - any sizing, sanitizing, foaming or not, Impermeable Barriers Isopropyl Alcohol Li-Ion Batteries, Small (Max Ari 200-36T) Medical Gowns N-95 Masks PAPR Filters PAPR Hoods, All Sizes - 3M or alternative brands Powered Air Purifying Respirators (PAPR) - MaxAir CAPR Systems Sanitizing/Disinfectant Wipes Surgical Procedure Masks Surgical Procedure Masks w/Shield Attached Ventilators Other (please specify) Question Title * 3. Please note in the space below any supplies, materials, and/or equipment that you would consider a "critical need" for your institution. Question Title * 4. We have the ability to procure these items, if required by the supplier/distributor/manufacturer. Yes No Question Title * 5. We have the ability to pick-up and transport supplies/equipment from an individual, organization or supplier/distributor. Yes No Question Title * 6. If available, we will need these supplies and/or equipment by the following date: Date Date Question Title * 7. Comments/Notes: (please consider using this space to provide any specific information that would help us better understand your needs, include quantities, sizes, specifications) Done