The following form is to provide an estimate of the Personal Protective Equipment that you have in your lab/work area that are considered excess. This is not to establish an absolute count but is to provide an estimate that may be available if the University receives a request from health care providers.

Marked fields are required.

Name:
Phone:
Email Address:
Building:
Room(s):

Number of Boxes of Disposable Gloves:

Number of N95 Respirators:
Number of Boxes of Surgical Style Masks:

Number of Masks per Box:

Number of Face Shields:
Number of Goggles:
Number of Safety Glasses:
Number of Disposable Lab Coats and/or Gowns:
Number of Containers of Disinfectant Wipes:
Number of Containers of Hand Sanitizer:

Average volume per Container of Hand Sanitizer: