Organizations/Individuals SC COVID-19 Organizations/Individuals Survey 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. What type of support are you offering? Supplier or distributor with immediate access to a stock of ready-made supplies/equipment Manufacturer with immediate access to a stock of ready-made supplies/equipment Organization with immediate access to a stock of ready-made supplies/equipment Individual with immediate access to a stock of ready-made supplies/equipment Manufacturer able to create new products Organization able to create new products Individual able to create new products Other (please specify) Question Title * 3. I/we are capable of doing the following: [Select all that apply] Donating supplies, material, and/or equipment Selling supplies, material, and/or equipment Both donating and selling supplies, material, and/or equipment Question Title * 4. [CRITICAL NEED ITEMS] I/We are capable of providing and/or producing the following critical need supplies and/or equipment. [Select all that apply]Note: Any additional detail related to items may be noted in the Comments/Notes field below. N-95 Masks Surgical Masks Face Shields Medical Gowns Ventilators Other (please specify) Question Title * 5. [GENERAL NEEDS] I/We are capable of providing and/or producing the following supplies and/or equipment. [Select all that apply]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 Facial Tissues Gloves, Exam, All Sizes - long cuff 11-12", nitrile 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 Bottles Hand Sanitizer Refills Hand Soap - any sizing, sanitizing, foaming or not Impermeable Barriers Isopropyl Alcohol Li-Ion Batteries, Small (Max Ari 200-36T) 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 * 6. What quantity of the identified supplies, materials, and/or equipment can you provide? Question Title * 7. If producing these supplies, materials, and/or equipment how many can you produce in one week? Question Title * 8. Do you have the supplies and materials necessary to produce these items or are they readily available? Yes No Question Title * 9. What is the earliest date these supplies, materials, and/or equipment will be available? Date Date Question Title * 10. Comments/Notes: (please consider using this space to provide any specific information that would help us better understand your capabilities or the items you have available, include quantities, sizes, specifications) Done