PPE Order Form
Revised: 07/14/2020
DIRECTIONS: Please fill out the following form and submit to ppe@potsdam.edu. When the order is
received and processed you will receive an order confirmation via email as well as an expected delivery
date. You will then be notified when your PPE is available for pickup at Raymond Hall 204. For any item
not listed below please email ppe@potsdam.edu with item, brand, size and quantity requested as well as a
brief justification.
***ALL ORDERS ARE DUE TO EHS BY THE 15
TH
OF EVERY MONTH***
Submitted By:_________________________________________ Date:________________________
Phone Number:_________________ Email:______________________________________________
Department/Building:_________________________________________________________________
Face Shields (Reusable) Universal
Safety Goggles (For over glasses)
3-Ply Medical Masks (Blue) Universal
N-95 Respirator (Universal)* ‡
Flame Resistant Face Covering
*If specialized N-95 masks required (Oil resistant, Mold, etc.) please indicate this in your email.
‡Medical evaluation and fit test must be completed AND on file prior to issuing