Fillable COVID 19 PROCUREMENT SUPPLIER DATABASE APPLICATION FORM a) (Kwazulu-Natal Department of Health)

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COVID 19 PROCUREMENT SUPPLIER DATABASE APPLICATION FORM a) (Kwazulu-Natal Department of Health)

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COVID 19 PROCUREMENT SUPPLIER DATABASE APPLICATION FORM
a) The registration form must be completed electronically, and emailed to
COVID19@treasury.limpopo.gov.za .
b) Applicants will be contacted via email and therefore must submit an operating email address.
c) Suppliers must take note of and adhere to the National treasury Instruction Note 05 of
2020/2021 which relates to procurement of PPEs, Annexure A of Price List.
1. SUPPLIER DETAILS
Company/Supplier Name
Company Registration Number
Manufacturer Yes/No
Central Supplier database Number
E-mail address
Contact Details
District
Business Physical address
2. LIST OF COMMODITIES (Principal business or services of company or supplier) Tick X next
to the commodities that the business is able to supply.
Product
Product description
WHO standards / description
TICK
WITH X
Capacity
per
month
Surgical Mask -
Patient
Mask, face, aseptic: Fluid Resistant,
Moulded , Blue (3 PLY), good
breathability, internal and external
faces should be clearly identified Type
I, with ear loops or tie on
- EN 14683 any type including
Type I
- ASTM F2100 minimum level 1
or equivalent
Surgical Mask -
Health Care
Worker
Mask, face, aseptic: Fluid Resistant,
Moulded, Blue (3 PLY), good
breathability, internal and external
faces should be clearly identified Type
II or higher, with ear loops or tie on
- EU MDD Directive 93/42/EEC
Category III or equivalent
- EN 14683 Type II, IR, IIIR
- ASTM F2100 minimum level 1
or equivalent
Mask Respirator
N95 or FFP2 - Mask Respirator / Dust
Mask, or higher.
Good breathability with design that
does not collapse against the mouth
(e.g. duckbill, cup-shaped)
- Minimum "N95" respirator
according to FDA Class II,
under 21
CFR 878.4040, and CDC
NIOSH, or
- Minimum "FFP2 according to
EN
149, EU PPE• Regulation
2016/425
Category III, or equivalent
Apron
Straight apron with bib,
Fabric: 100% polyester with PVC
coating, or 100% PVC, or 100%
rubber, or other fluid resistant coated
material.
Waterproof, sewn strap for neck and
back fastening.
Minimum basis weight: 300 g/m2,
Covering size: 70 - 90 cm (width) x
120 - 150 cm (height).
Reusable (provided appropriate
arrangements for decontamination are
in place)
• EN ISO 13688
• EN 14126-B and partial
protection
(EN 13034 or EN 14605)
• EN 343 for water and
breathability
or equivalent
Select a district
Eye Protection
Goggles
Good seal with the skin of the face,
flexible PVC frame to easily fit with all
face contours with even pressure,
enclose eyes and the surrounding
areas, accommodate wearers with
prescription glasses, clear plastic lens
with fog and scratch resistant
treatments, adjustable band to secure
firmly so as not to become loose
during clinical activity, indirect venting
to avoid fogging. May be re-usable
(provided appropriate arrangements
for decontamination are in place) or
disposable.
• EU PPE Regulation 2016/425
• EN 166
• ANSI/ISEA Z87.1 or equivalent
Visor / Face Shield
Made of clear plastic and providing
good visibility to both the wearer and
the patient. Adjustable band to attach
firmly around the head and fit snuggly
against the forehead, fog resistant
(preferable). Completely cover the
sides and length of the face. May be
re-usable (made of robust material
which can be cleaned and disinfected)
or disposable.
• EU PPE Regulation 2016/425
• EN 166
• ANSI/ISEA Z87.1 or equivalent
Isolation Gowns
Isolation gown
Protective 3- layers of spun bond melt
blown spun bound fabric( Top layer of
spun bound polypropylene, a middle
layer of meltdown polypropylene and
a bottom layer of meltdown
polypropylene for light fluid contact
and contact Isolation, elastic cuff,
Tape-tab neck closure, Tie waist, Non
Sterile
Dimensions: Large
Length: (from shoulder to hem) 116cm
Sleeve length: (from shoulder to wrist)
56cm
Belt length: 167cm; Belt Width: 5cm;
Belt place: (neck to top of belt) 38cm
• EU PPE Regulation 2016/425
and EU
MDD Directive 93/42/EEC
• FDA Class I or II medical
device,
or equivalent
• EN 13795 any performance
level, or
• AAMI PB70 all levels
acceptable,
or equivalent
Surgical Gowns
Gown, surgical, non-woven
polypropylene body+- 54g/m sleeves
+- 66g/m. Long sleeves with cuffs.
Reinforced in chest and forearm
areas. Resistant to liquid penetration.
Lint free, non-flammable, Bacteria
barrier efficiency, to comply with
SANS 53795, Compliance certificate
to be submitted, Sterile, individual
double peel packed
• EU PPE Regulation 2016/425
and EU
MDD Directive 93/42/EEC
• FDA Class I or II medical
device,
or equivalent
• EN 13795 any performance
level, or
• AAMI PB70 all levels
acceptable,
or equivalent
Coveralls
Protective cover bodysuits,
disposable
MEDIUM, LARGE, X-LARGE, XX-
LARGE, 3X LARGE
Tunic/tops, woven, scrubs,
reusable or single use, short
sleeved (tunic/tops), worn
underneath the coveralls or
gown.
Trouser/pants, woven, scrubs,
reusable or single use, worn
underneath the coveralls or
gown
Boot Covers
Overshoe, non-woven, single use. To
be made from durable, water-
repellent, opaque material Seam free
under sole. Elasticated opening.
Suitable for all size shoes
Digital Thermometer
Digital Body Thermometer
INFRARED NON CONTACT
Sanitisers and
Disinfectants
Sanitizer, with not less than 70%
alcohol
must comply to WHO-recommended
hand rub formulations
Biohazard bags
Bright red colour PP bags are easy to
open and are used to dispose used
Micro tips, Tubes and other plastic
products.
Disposal bag for bio-hazardous
waste, 30x50cm, with "Bio
Hazard" print, auto cleavable
polypropylene. 50 or 70 micron
thickness
Body Bags
Manufactured from 280 micron
reinforced PVC, both ends are
stitched and sealed to prevent any
leakage, There must be 3 handles on
each side with a full length curved zip,
all handles must be box stitched using
Poly cotton Core spun Polished 36
Tex thread, and box stitching
dimensions are all 4cm x 3cm. The
dimensions are as follows: Length:
2.4 METERS Width: 1 METER, Zip:
1.8 METERS, Sizes:(Child, Small,
Medium, Large, Extra-large)
Examination Gloves,
non-sterile
Gloves, examination, nitrile, powder-
free, non-sterile, single-use Gloves
should have long cuffs, reaching well
above the wrist, ideally to mid-
forearm. Sizes: small, medium, large.
• EU MDD Directive 93/42/EEC
Category III
• EU PPE Regulation 2016/425
Category III
• EN 455
• EN 374
• ANSI/ISEA 105,
• ASTM D6319,or equivalent
Gloves, examination
or surgical, sterile
Gloves - surgical or examination -
nitrile, powder-free, sterile, single-use.
Gloves should have long cuffs,
reaching well above the wrist, ideally
to mid-forearm. Sizes: small, medium,
large.
• EU MDD Directive 93/42/EEC
Category III,
• EU PPE Regulation 2016/425
Category III,
• EN 455,
• ANSI/ISEA 105,
• ASTM D6319or equivalent
Cloth Mask
Mask - 2 layers of fabric (As per the
DTIC guidelines & Specifications
Mask - 3 layers of fabric (As per the
DTIC guidelines & Specifications
______________________
FULL NAMES OF OWNER / DELEGATED DESIGNATION:
AUTHORISED REPRESENTATIVE
DATE:
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COVID 19 PROCUREMENT SUPPLIER DATABASE APPLICATION FORM a) (Kwazulu-Natal Department of Health)

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Completed 1 April 2021

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