Form Page | Gloucestershire Health and Care NHS Foundation Trust

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Emergency PPE Stock Order Form

Name *

First Last

Name of organisation *

Organisation location *

Contact telephone number *

Contact email address *

Email address of colleague

If you'd like a colleague to receive a copy of your order, please enter their email address above.

Select the hub you would like to collect from: *

Cirencester Hospital

Edward Jenner Court

Lydney and District Hospital

North Cotswolds Hospital

Type IIR masks

These masks are no longer available through the Central Stock Management Team, but can now be ordered through Integra Centros if required - BWM85089

FFP2 and FFP3 masks

Please only order the type that you have passed a fit test on.

FFP2 masks

Price:

Please specify how many items not boxes

Quantity

Please enter a number from 0 to 100.

FFP3 masks

Price:

Please specify how many items not boxes

Quantity

Please enter a number from 0 to 50.

Please specify which type of FFP3 you have been fit tested on

Gowns and Overalls

Aprons

Price:

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Quantity

Please enter a number from 0 to 2000.

Long sleeved gowns (M)

Price:

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Quantity

Please enter a number from 0 to 100.

Long sleeved gowns (L)

Price:

Please specify how many items not boxes

Quantity

Please enter a number from 0 to 100.

Long sleeved gowns (XL)

Price:

Please specify how many items not boxes

Quantity

Please enter a number from 0 to 100.

Gloves

Gloves (all sizes) are no longer available via this service.

small gloves

Price:

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Quantity

Please enter a number from 01 to 3000.

medium gloves

Price:

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Quantity

Please enter a number from 0 to 3000.

large gloves

Price:

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Quantity

Please enter a number from 0 to 3000.

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Face shields, glasses/goggles

Face shields

Price:

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Quantity

Please enter a number from 0 to 200.

Resuable glasses/goggles

Price:

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Quantity

Please enter a number from 0 to 50.

Hand gel

Hand gel (500ml)

Price:

Please specify how many items not boxes

Quantity

Please enter a number from 0 to 20.

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