Central Stock Management Step 1 of 2 50% PPE Stock Order FormOrders need to be received by 12pm on the day before you wish to collect your stock. The hub coordinator will email you to confirm your order will be available and to clarify any items where needed. Please remember to bring a copy of your order and something to carry the PPE in when you collect. For details about hub opening times, please visit the intranet.Name * REQUIRED First Last Team the request is for * REQUIRED Team location * REQUIRED Contact 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.We would like to * REQUIRED collect our order from a stock hub receive a drop delivery (deliveries are by pre-arrangement only) Select the hub you would like to collect from: * REQUIRED Cirencester Hospital Edward Jenner Court Lydney Hospital North Cotswolds Hospital Pullman Place Stroud Hospital Tewkesbury Hospital The Vale Hospital Wotton Lawn Hospital When would you like to collect? - must be dd/mm/yyyy format * REQUIRED DD slash MM slash YYYY Select 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 ClinicOther Please specifyDo you require your order to be split across different sites? If yes, please give details and quantitiesType IIR masksType IIR masks Price: Please specify how many items not boxesQuantityType IIR masks for mask stations Price: Please specify how many items not boxesQuantityFFP3 masksPlease only order the type that you have passed a fit test on.3M 9330+ Price: Please specify how many items not boxesQuantityAlpha Solway Price: Please specify how many items not boxesQuantityAlpha Solway HX-3 Price: Please specify how many items not boxesQuantityHalyard Price: Please specify how many items not boxesQuantityValmy Price: Please specify how many items not boxesQuantityGVS 31000 Price: Please specify how many items not boxesQuantityHandahny 9330 Price: Please specify how many items not boxesQuantityHandahny 9632 Price: Please specify how many items not boxesQuantityDrager Price: Please specify how many items not boxesQuantityOther Please specify type and quantityAprons and gownsAprons Price: Please specify how many items not boxesQuantityLong 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 boxesQuantityGlovesx small gloves Price: Please specify how many items not boxesQuantitysmall gloves Price: Please specify how many items not boxesQuantitymedium gloves Price: Please specify how many items not boxesQuantitylarge gloves Price: Please specify how many items not boxesQuantityx large gloves Price: Please specify how many items not boxesQuantityVisorsVisors Price: Please specify how many items not boxesQuantityAlcohol based hand rubHand rub (small) Price: Please specify how many items not boxesQuantityHand rub (medium) Price: Please specify how many items not boxesQuantityHand rub (large) Price: Please specify how many items not boxesQuantityWaste bagsOrange waste bags Price: Please specify how many items not boxesQuantityTiger waste bags Price: Please specify how many items not boxesQuantityHand wash and chlorine tabletsHand wash Price: Please specify how many items not boxesQuantityChlorine tablets Price: Please specify how many items not boxesQuantityOtherPlease give details of any items and quantities you want to order that are not listedDate - must be mm/dd/yyyy format MM slash DD slash YYYY
