PPE Order Form

The Oregon Home Care Commission (OHCC) has PPE available for providers who require it to safely support their consumer-employers' service needs. Monthly PPE supplies can be ordered every 30 days (or as needed) by completing this request.

For emergent needs, contact your local office where gloves and masks are available until your OHCC order arrives.

1. Provider Number

2. Last Name

3. First Name

4. Email Address

5. Street Address

6. City

7. State

8. Zip Code

9. The number of employers that you work for in which you need PPE

10. Gloves (If you need gloves, select one size only)

11. Masks

Disposable

12. For providers with a high risk of exposure to disease or illness in the workplace extra precaution PPE is available and listed below.

Examples:

N-95 masks are used to protect when there is risk of transfer of microorganisms, body fluids, and particulate materials.
Face Shields are used when there is a need to protect your eyes, nose, mouth and face from liquids and flying objects.
Gowns are for providers who come in contact with potentially infectious liquid or solid material.
Shoe coverings are for providers when there is a likelihood of body fluids that might splash, spill or leak on their shoes.

N-95 or KN-95 Masks (whichever is available)
Face shields
Gowns
Shoe coverings