Canyon County COVID-19 PPE Request & Daily Use Survey Point of Contact (POC) filling out this survey* First Last POC's email address* POC's phone number*Name of Agency/Office/Department* Entity Type* County City State Tribal Private/Non-Profit For Profit Date of request* MM slash DD slash YYYY Time of request* : Hours Minutes AM PM AM/PM PPE Request & Daily Use SurveyAttention: Numbers are for actual individual items or units, not boxes or cases. Example: Enter 100 gloves NOT 50 for a pair or 1 for a box. Please enter zero (0) if the category doesn't apply to youN-95 or KN95 Masks*How many N-95 or KN95 masks were used today?Amount being requestedEstimated inventory of N-95 or KN95 masks on handSurgical Masks*How many surgical masks were used today?Amount being requestedEstimated inventory of surgical masks on handDisposable Coveralls*How many disposable coveralls were used today?Amount being requestedEstimated inventory of disposable coveralls on handDisposable Gowns*How many disposable gowns were used today?Amount being requestedEstimated inventory of disposable gowns on handGloves (nitrile or latex)*How many gloves (nitrile or latex) were used today?Amount being requestedEstimated inventory of gloves (nitrile or latex) on handGoggles*How many goggles were used today?Amount being requestedEstimated inventory of goggles on handFace Shields*How many face shields were used today?Amount being requestedEstimated inventory of face shields on handCloth Masks/Face Coverings*How many cloth masks/face coverings were used today?Amount being requestedEstimated inventory of cloth masks/face coverings on handNon-Medical Grade Gloves*How many non-medial grade gloves were used today?Amount being requestedEstimated inventory of non-medical grade gloves on handCAPTCHANameThis field is for validation purposes and should be left unchanged.
