Step 1 of 2 50% PPE Stock Order Form• Orders must be received by 12pm at the latest on the day before you wish your stock to be delivered. The Central Stock Management Team will email you to confirm your order and to clarify any details where needed. Please note; if items are not listed in the form, they are no longer available for order from us.Update: Monday 17 April 2023From Monday 17 April 2023 some items of PPE will no longer be available from the Government-funded, free-to-Trusts PPE service. Please refer to the order form for the latest items no longer available. These items will now need to be requested via the NHS Supply Chain (Integra), as per pre-COVID processes, and will no longer be supplied by the Stock Management team. All other PPE items, as per order form, should still be requested via the Stock Management team until otherwise indicated.Name * REQUIRED First Last Team the request is for / comments * REQUIREDRequired date of delivery * REQUIREDDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Team location * REQUIREDContact telephone number * REQUIREDContact email address * REQUIRED Email address of colleague If you'd like a colleague to receive a copy of your order, please enter their email address above. This field is hidden when viewing the formWe would like to * REQUIRED collect our order from a stock hub receive a drop delivery (deliveries are by pre-arrangement only) This field is hidden when viewing the formSelect the hub you would like to collect from: * REQUIRED Cirencester Hospital Edward Jenner Court Lydney Hospital North Cotswolds Hospital Stroud Hospital Tewkesbury Hospital The Vale Hospital Wotton Lawn Hospital This field is hidden when viewing the formWhen would you like to collect? * REQUIREDDayDay12345678910111213141516171819202122232425262728293031MonthMonth123456789101112YearYear20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920This field is hidden when viewing the formSelect a delivery location * REQUIRED Cheltenham Gloucester Forest of Dean Tewkesbury District Nurses Newent District Nurses North Cotswolds Which Cheltenham location? * REQUIREDCharlton Lane HospitalILCSpringbankSt Pauls - Laurel HouseSt Pauls - HoneybourneSt Pauls - Brownhill CentreSt Pauls DentalSt Pauls - Stanway CentreMilsom StreetLexham LodgeOtherWhich Gloucester ICT location? * REQUIREDBearlandsSouthgate MooringsStakes HayOtherWhich Forest of Dean location? * REQUIREDColliers CourtDean HouseOtherWhich North Cotswolds location? * REQUIREDGeorge Moore Community CentreGeorge Moore Community ClinicOtherPlease specifyThis field is hidden when viewing the formDo you require your order to be split across different sites? If yes, please give details and quantitiesType IIR masksIIR masks These masks are no longer available through the Central Stock Management Team, but can now be ordered through Integra Centros if required - BWM85089 FFP3 masksPlease only order the type that you have passed a fit test on.Please note: The Trusts Decontamination Lead and FFP3 Fit Test Team Lead confirms that the 3M 1863+ and the 3M 9330+ are interchangeable, both are made in the UK (as stipulated on the packaging) and have the same performance and identical appearance so are identical masks that are interchangeable.3M 1863+ masks These masks are no longer available through the Central Stock Management Team, but can now be ordered through Integra Centros if required - BWG85087 Mask Respirator FFP3 Aura Particulate Healthcare Flat folded Unvalved (3M 1863+)Alpha Solway HX-3 Price: Please specify how many items not boxesQuantityAlpha-Solway SS-3V These masks is no longer available through the Central Stock Management Team, but can now be ordered through Integra Centros if required - BWG85081 Mask Respirator FFP3 Elastic Headband valved cone style adjustable straps metal free preformed nose bridge (suitable for smaller face shapes) (Alpha-Solway)Medicom Kolmi Regular Price: Please specify how many items not boxesQuantityMedicom Kolmi Small Price: Please specify how many items not boxesQuantityValmy Price: Please specify how many items not boxesQuantityGVS 31000 Price: Please specify how many items not boxesQuantityDrager Price: Please specify how many items not boxesQuantityGownsLong sleeved gowns (Size M) Price: Please specify how many items not boxesQuantityLong sleeved gowns (Size L) Price: Please specify how many items not boxesQuantityLong sleeved gowns (Size XL) Price: Please specify how many items not boxesQuantityGlovesExtra small gloves Price: Please specify how many items not boxesExtra small gloves are no longer available from the stock team. Teams are requested to order direct from the NHS supply chain. QuantityVisorsVisors Price: Please specify how many items not boxesQuantityMiscellaneous consumablesCotton wool Price: Requested as bags of 200 ballsQuantityShoe covers (one size) Price: Requested as 100 pairs per bagQuantityDate Day Month Year CAPTCHA