Personal Protective Equipment (PPE) Needs Survey

The deadline to request PPE through this program was January 20, 2021. For more information, please see IDHS Community PPE Program Frequently Asked Questions or contact with any questions.

Please specify the item count needed for each of the below:

PPE Count
Preventative/Sanitizing Items Count

* if reusing PPE per guidelines

(e.g., in home care worker who enters 5 homes per day and must be in close
contact with the client in order to successfully perform job)

Please indicate which, if any, of the following agencies you have contracted with: