COVID-19 VENDOR SUPPLIES AVAILABILITY
This survey is designed to take inventory of all medical supplies available to assist in combating the COVID-19 crisis.
Vendor Information
Vendor Information
Vendor Name
*
Vendor Address
*
Contact Name
*
Contact Email
*
Contact Phone
*
Supplies Information
Supplies Information
N95s Available
*
Yes
No
Are the N95s surgical-grade?
*
Yes
No
Are they NIOSH Approved?
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Gowns Available
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Masks Available
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Gloves Available
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Face Shields Available
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Hand Sanitizer Available
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Disinfectant Supplies Available
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Nasopharyngeal Swabs Available
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Oropharyngeal (OP) Swabs Available?
*
Yes
No
Are the products in the original packaging?
Yes
No
FDA Registration Number
FDA ID Information
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($)
How many are available?
Other Supplies Available
Yes
No
Other Supplies Description
What is the earliest date these supplies could be delivered?
mm/dd/yyyy
Price per unit ($) of each item listed in "other" supplies
*
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