Fillable Kleenex, 100/box Disinfectant Wipes, Canister, 75/80 sheets Hand (University of Central Arkansas)

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Kleenex, 100/box Disinfectant Wipes, Canister, 75/80 sheets Hand (University of Central Arkansas)

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Department: Date:
Pick Up: Deliver:
Select One:
Quantity Requested Balance
Requested by: Phone:
Department Head/Chair Approval: Date:
Dean/Vice President Approval: Date:
Suppli
es Received By:
Print Name
Date:
Signature
Verified By: Date:
Physical Plant Official
UNIVERSITY OF CENTRAL ARKANSAS
PPE SUPPLY REQUEST FORM
Description
Quantity Received
Kleenex, 100/box
Face Shields
Gloves, Nitrile, S, 100/box
Gloves, Nitrile, M, 100/box
Gloves, Nitrile, L, 100/box
Gloves, Nitrile, XL, 100/box
Gloves, Nitrile, XXL, 100/box
Disinfectant Wipes, Canister, 75/80 sheets
Screen Cleaning Wipes, Canister
Hand Sanitizing Gel, 16.9 oz with Pump
Hand Sanitizing Gel, 8 oz with Pump
Hand Sanitizing Gel, 32 oz with Pump
Hand Sanitizing Gel, 1 Gallon with Pump
Hand Sanitizing Station, Gel, Free Standing
Hand Sanitizing Wall Dispensers
Hand Sanitizing Station Refills
Hand Sanitizing Wipes, Canister
Alcohol Wipes, 100/box
Disposable Face Masks, Medical
Disposable Face Masks, Non-Medical
KN95 Masks, 5/pack
N95 Masks
Hospital Grade Disinfectant Concentrate, Gallon
Disposable Gowns, Isolation, Sterile
Surgical Caps, Bouffant
Surgical Mask, 3 ply Medical with tie back
Disinfecting Wipes, Tub, 500 sheets
Lysol Disinfecting Spray, Can
Web Cams
Batteries, AA
*University Doctor's Approval: __________________________________________
(For N95 Masks Only) Signature
Date: ____________
Copy of this document will be given to the recipient of the supplies.
Please email this form upon approval to: pplantwarehouse@uca.edu
*Requires the University Doctor's approval
Batteries, AAA
No Touch Thermometers
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Kleenex, 100box Disinfectant Wipes, Canister, 7580 sheets Hand (University of Central Arkansas)

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Completed 24 July 2020

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