EOC Request Form

Instructions
Requesting multiple items: You can use this form to request multiple items (i.e. hand sanitizer and face coverings) by clicking the 'Add another response' link at the bottom right corner of the ‘Requested Resources’ section.

For community groups responding to Respiratory Illness:

 

Multnomah County is distributing bulk hand sanitizer, disposable face coverings, and face shields (for specific uses) at no charge. We are working in partnership with non-profit organizations and community groups that primarily serve people at highest risk.

 

If you receive any of these items, you may not charge a price or ask for payment of any kind for them.

 

For healthcare providers, first responders, and healthcare support agencies:

 

We are currently offering Personal Protective Equipment (PPE) to healthcare providers and healthcare support agencies, and government agencies. PPE includes but is not limited to: N95s, procedure masks, gloves and gowns. 

PPE is set aside to support life safety operations. We may be unable to fill your full request if it is for limited resources.

In order to process your request promptly, please complete this form carefully. Incomplete requests can DELAY processing.

 

Face shields for specific uses

Multnomah County is distributing face shields at no charge for specific uses, including:

 

  • When a person has a medical condition that prevents them from wearing a mask or face covering.

  • When people need to see mouth and tongue motions in order to communicate (e.g., for communicating with children in certain developmental stages or people with hearing impairments).

Before requesting face shields, read these considerations for face shields from the CDC. 

Contact Information 

For help submitting a resource request or to follow-up on a resource request you have already submitted, please contact the Community Resources Unit. 

 

We will return your call or contact you for more information Mon-Fri 9am - 4pm PST.

 

Email:

eoc-community-resources-unit@multco.us

Phone: 503-988-5952





Please consult your local City or County Emergency Operations Agency. This form is for organizations that serve Multnomah County.








Please place an order with a traditional supplier. Once you have placed an order with a supplier, you may submit a resource request with Multnomah County. Agencies who receive resources from the County, State or Federal government should anticipate financial responsibility and may be required to reimburse all or some of the costs.

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Requester Information

Requesting Point of Contact




Enter phone number without spaces or dashes


Submitted by Information
This section should be completed if the person submitting this request is different than the organization/person requiring the resources.

Form Completed By:






Requested Resources

Personnel: A single position needed that may be filled by multiple people over multiple shifts.
Team: multiple types of positions needed reporting to the same EOC leader.
Assistance: Support needed from a person to complete a limited duration task(s) who will not/does not report to the requester - site setup or movement of equipment.
Equipment: multi-use items, laptop, phone, furniture, printers
Supplies: single-use/consumable items, food, masks, gloves, paper/pens






All Hand Sanitizer is Gel and comes in 8oz or 1-gallon bottles. Please check which size you would like to receive. You may request both sizes, but you will have to make a separate Resource Request for each size. For Quantity needed, please put the total # of bottles you are requesting.




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Work Location






















(Facility Specification Sheet , 204 Position Description Item Example, Vehicle Specifications)

(i.e. Specific task details, specific hours or days of the week needed)

  • If you are planning on request COVID-19 self-tests from the Oregon Health Authority (OHA), please fill out the OHA testing kits request sheet. This will be a separate request submission directly to OHA.


Additional N95 Mask Info


Respiratory Protection Program: The Occupational Safety and Health Administration (OSHA) requires employers to develop and implement a written respiratory protection program for situations in which permissible exposure limits (PELs) of airborne contaminants are exceeded, or when the employer requires the use of respirators by employees.

Respiratory fit testing: tests the seal between the respirator's face piece and your face. It takes about fifteen to twenty minutes to complete and is performed at least annually. After passing a fit test with a respirator, you must use the exact same make, model, style, and size respirator on the job. If you receive a N95 model from us that you have not previously used, you will need to perform a new fit test for this model.


Delivery Details







Receiving Point Of Contact (if different than requester):





Hidden Values

Contact Information