The Provincial Emergency Fleet Request Form

 

Requestor Information

 
 
 
 

Health Authority that requested the device

 

 

Shipping Information

 
 
 
 
 
 
 

 

Background Information

 
 

Please provide more details on why the equipment is needed?

 
 
 
 
 

 

Urgency

 
 

Please describe the urgency of the request in more details

 
 
 

 

Equipment Information

 
 

Please note, local Biomedical Engineering team is responsible for maintaining and repairing the loan device as per its schedule. All part costs for maintenance are covered by PHSA. Should you require parts, kindly contact us at emergencyfleet@phsa.ca.