Prevention Safe Business Operations Business FAQs Food Service Facility Guidance Local Resolutions State Directives Events Facemasks Recommendations Required Use of Face Coverings Resolution Trip Planning Travel Planner Testing Testing Clinics At-Home Testing Kits FREE COVID Testing Kits Vaccination Vaccine Clinics Vaccination Booster Eligibility What You Need to Know About Variants Local COVID-19 Data Latest News Resources Dept. of Health PPE Request Form Wellness Check In Menu Prevention Safe Business Operations Business FAQs Food Service Facility Guidance Local Resolutions State Directives Events Facemasks Recommendations Required Use of Face Coverings Resolution Trip Planning Travel Planner Testing Testing Clinics At-Home Testing Kits FREE COVID Testing Kits Vaccination Vaccine Clinics Vaccination Booster Eligibility What You Need to Know About Variants Local COVID-19 Data Latest News Resources Dept. of Health PPE Request Form Wellness Check In Personal Protective Equipment (PPE)Request Form Fill out the form below to submit your request for Personal Protective Equipment (PPE). You can also download a printable version of this form by clicking the button below and emailing your completed form to mdh.charlescountycccaresppe@maryland.gov. Download Printable PPE Form Please enable JavaScript in your browser to complete this form.Name *Phone No.Email *Organization NameOrganization AddressOrganization TypeNo. Employees/StaffAverage No. ServedITEMAVAILABLE SUPPLYREQUESTED NO.Hand Sanitizer (10-12 oz)Hand Sanitizer (10-12 oz) SupplyHand Sanitizer (10-12 oz) RequestHand Sanitizer (Gallon Refill)Hand Sanitizer (Gallon Refill) SupplyHand Sanitizer (Gallon Refill) RequestHand Sanitizer Dispenser StandHand Sanitizer Dispenser SupplyHand Sanitizer Dispenser RequestMed Approved N95 (35/box)Med Approved N95 SupplyMed Approved N95 RequestN95 (5/pack)N95 SupplyN95 RequestKN95 (10/box)KN95 SupplyKN95 RequestSurgical Mask (50/box)Surgical Mask SupplySurgical Mask RequestWashable Mask (Youth, Adult)Washable Mask SupplyWashable Mask RequestFace Shield/Goggles (10/pack)Face Shield SupplyFace Shield RequestGloves M/L (100 per box)Gloves SupplyGloves RequestDisinfectant Wipes (80/pack)Disinfectant Wipes SupplyDisinfectant Wipes RequestDisinfectant Spray (gallon)Disinfectant Spray SupplyDisinfectant Spray RequestGowns/Lab Coat (10/pack)Gowns SupplyGowns RequestHair Covers (100/pack)Hair Covers SupplyHair Covers RequestShoe Covers (100/pack)Shoe Covers SupplyShoe Covers RequestThermometers (1/box)Thermometers SupplyThermometers RequestPulse Ox (1/box)Pulse Ox SupplyPulse Ox RequestBlood Pressure Cuffs w/wo Gauge (1/pack)Blood Pressure Cuffs SupplyBlood Pressure Cuffs RequestStethoscope (1/pack)Stethoscope SupplyStethoscope RequestAir Freshener (12/case)Air Freshener SupplyAir Freshener RequestToilet Seat Cover (250/pack)Toilet Seat Cover SupplyToilet Seat Cover RequestDate of RequestOrganization in Charles County?YesNoSubmit