Washington State DSHS PPE Order Request Form
The Washington State Department of Social and Health Services PPE Order Request Form is for individual providers to request personal protective equipment. Complete this form as a first step in acquiring necessary PPE. The form includes client information, COVID status details, and PPE requirements.
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How do I fill this out?
To fill out this form, start by providing your personal and contact details. Then, indicate the COVID-19 status of yourself and your clients, and specify the number of clients. Finally, list the PPE required based on the COVID-19 status and the quantity needed.
How to fill out the Washington State DSHS PPE Order Request Form?
1
Provide your personal and contact details.
2
Indicate the COVID-19 status of yourself and your clients.
3
Specify the number of clients.
4
List the PPE required based on the COVID-19 status.
5
Specify the quantity of each PPE item needed.
Who needs the Washington State DSHS PPE Order Request Form?
1
Individual providers needing PPE for confirmed COVID-19 cases.
2
Healthcare workers requesting PPE for suspected COVID-19 cases.
3
Social service workers needing PPE for COVID-negative clients.
4
Caregivers who need to protect themselves while assisting clients.
5
Community health workers needing PPE for multiple clients.
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What are the instructions for submitting this form?
Submit the completed PPE Order Request Form through the following ways: Email: ppe_request@dshs.wa.gov Fax: (123) 456-7890 Online Submission Form: https://www.dshs.wa.gov/ppe-request Physical Address: Washington State Department of Social and Health Services, PPE Request Processing Center, 1234 Health St., Olympia, WA 98501. My advice is to ensure all fields are completed accurately to prevent delays in processing your request.
What is the purpose of this form?
The purpose of the Washington State DSHS PPE Order Request Form is to streamline the process for individual providers to obtain necessary personal protective equipment (PPE). This ensures that healthcare workers, social service workers, and caregivers have the required PPE to protect themselves and their clients from potential COVID-19 exposure. By completing this form, providers can clearly communicate their PPE needs, based on the number of clients they serve and their COVID-19 status.
Tell me about this form and its components and fields line-by-line.
- 1. Requestor Name: The name of the individual provider making the PPE request.
- 2. Phone Number: Contact number for the requestor.
- 3. Email Address: Email address for communication regarding the PPE request.
- 4. Shipping Address: Address where the PPE will be shipped.
- 5. Number of Clients: Total number of clients served by the requestor.
- 6. COVID Status: Indicates whether the requestor or any clients have confirmed or suspected COVID-19 infection.
- 7. # COVID+ clients: Number of clients with confirmed or suspected COVID-19.
- 8. # COVID- clients: Number of clients without COVID-19.
- 9. PPE Requirements: List of needed PPE items and their quantities based on COVID status.
What happens if I fail to submit this form?
Failure to submit the PPE Order Request Form may result in delayed or unmet PPE needs.
- Inadequate PPE Supply: Healthcare workers and caregivers may not have the necessary PPE to protect themselves.
- Increased COVID-19 Exposure Risk: Lack of PPE may increase the risk of COVID-19 transmission among clients and providers.
How do I know when to use this form?
- 1. Confirmed COVID-19 Cases: When a provider has clients with confirmed COVID-19 infection.
- 2. Suspected COVID-19 Cases: When a provider has clients with suspected COVID-19 infection.
- 3. Multiple Clients: When a provider serves multiple clients who need PPE.
- 4. High-risk Environments: When working in environments with a high risk of COVID-19 exposure.
- 5. Routine PPE Replenishment: When regularly replenishing PPE supplies to maintain protection standards.
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Click the share button, choose a method, and send the PDF to your recipient.
How quickly will my PPE order be processed?
After completing the form, your PPE shipment will be processed within 24-72 hours.
What information do I need to complete the form?
Provide your contact details, client numbers, COVID-19 status, and required PPE quantities.
Can I make changes to the form after downloading?
Yes, you can re-upload the form to PrintFriendly for further edits and adjustments.
Is there a limit to the number of clients I can list?
No, you can list as many clients as necessary to ensure accurate PPE distribution.
What if I need additional PPE not listed?
Contact the Washington State Department of Social and Health Services for special requests.
How do I know which PPE items I need?
Refer to the COVID-19 status section and the PPE requirements listed for guidance.
Are there any shipping costs for the PPE?
No, the PPE will be shipped to you at no cost within 24-72 hours after completing the form.
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