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PPE Order Form

Physicians can submit this PPE Order Form once per two-week period.

  • Delivery Address (NO P.O. Boxes)
  • Gloves – MAXIMUM total of 2 boxes of gloves (i.e. the Order Quantity column must equal no more than 2*)
  • ITEM IDENTIFIER #
  • DESCRIPTION
  • PACKAGE SIZE
  • ORDER QTY. MAX 2*
  • Combined order of all glove sizes not to exceed 2 box max.
  • FIT300S
  • Gloves Exam Nitrile Small
  • 300/Box
  • Box(es)
  • FIT300M
  • Gloves Exam Nitrile Medium
  • 300/Box
  • Box(es)
  • FIT300L
  • Gloves Exam Nitrile Large
  • 300/Box
  • Box(es)
  • UNAVAILABLE
  • Gloves Exam Nitrile X-Large
  • 300/Box
  • Gowns – MAXIMUM 1 case
    Only unrated isolation gowns are currently available. The Public Health Agency of Canada guidelines do not specify a minimum rating. Unrated non-impervious gowns can provide a level of protection appropriate in circumstances where higher rated gowns are not necessary.
  • ITEM IDENTIFIER #
  • DESCRIPTION
  • PACKAGE SIZE
  • ORDER QUANTITY
  • KC69127
  • Non-Impervious Gowns (Blue)
  • 100/Case
  • Case (max 1)
  • Masks – MAXIMUM 3 boxes
    Follow the directive on the Continuous Use of Masks for Full Shifts in Health-care Setting (hyperlink). Continuous use of masks is the practice of wearing the same mask for repeated close contact with different patients, without removing the mask between patient encounters. The duration of the continuous use is dependent on the nature of the task or activity being undertaken. It is recommended that health care workers minimize their mask use to two masks per shift where possible.
  • ITEM IDENTIFIER #
  • DESCRIPTION
  • PACKAGE SIZE
  • ORDER QUANTITY
  • KC48201DOH
  • Surgical Masks
  • 50/Box
  • Box(es) (max 3)
  • Goggles – MAXIMUM 2
    Adhere to recommended manufacturer instructions for cleaning and disinfection. When manufacturer instructions for cleaning and disinfection are unavailable, consider: clean it with soap and water and then disinfect it with a bleach solution of 1 part bleach to 9 parts water, being mindful not to contaminate the environment with the eye protection.
  • ITEM IDENTIFIER #
  • DESCRIPTION
  • PACKAGE SIZE
  • ORDER QUANTITY
  • S2500C
  • Reusable Goggles
  • Each
  • Unit(s) (max 2)
  • Sanitizer Wipes – MAXIMUM 1 container and MAXIMUM 1 bottle
    Hospital grade disinfectant (e.g., disinfectant wipes) using the recommended contact time should be used to disinfect smaller resident care equipment (i.e. BP cuffs, electronic thermometers, oximeters, stethoscope) after each use.
  • ITEM IDENTIFIER #
  • DESCRIPTION
  • PACKAGE SIZE
  • ORDER QUANTITY
  • JOL5144708
  • Disinfectant Wipes
  • 160/Container
  • Container (max 1)
  • Bottle without pump
  • Alcohol Based Hand Sanitizer (ABHS)
  • 950 ml squeezable bottle
  • Bottle (max 1)