Volunteer Fairfax - PPE/Cloth Masks/Essential Items Donation Survey
RequiredRequired Question(s)
Please complete this survey to help Volunteer Fairfax better source donations.  If you experience problems submitting this survey, please click on this link to re-access the survey.

  • Personal protective equipment (PPE): The Fairfax County Health Department staff rely on personal protective equipment (PPE) when conducting contact investigations in settings housing our most vulnerable residents, including those residing in skilled nursing and assisted living facilities.

    In addition, Fairfax County seeks to support our safety net providers providing essential health care services to underinsured and uninsured residents.

  • Sewn cloth face coverings/masks:
    Donations are needed to protect the most vulnerable within our community and will support nonprofit providers and the low-income client households they serve.

    Please note: If you are a medical practice or long term care facility and are in need of PPE, we have been asked to connect you with the Fairfax County Health Department. Please email them at HDLiaison@fairfaxcounty.gov and share your supply need with them for better assistance.

  • Child Care Provider priority items: 
    The Office for Children is seeking donations to support child care programs countywide in providing essential services to children and families. Donated supplies will support healthy hygiene practices and help child care centers and family child care programs maintain a clean and healthy environment.
Please complete
 
Required 1.
Please provide your contact information, so we can be in touch to discuss your donation offer.

First Name:
Last Name:
Work Phone:
Home Phone:
Email Address:
emailaddress@xyz.com
Address 1:
Address 2:
City:
State/Province
(US/Canada):
Postal Code:

Required 2.
Is the offer on behalf of an individual or organization? 
Individual
Organization
  • Comment:

  • 500 characters left.
3.
Is the PPE supply offer a donation? 
Yes
No
Required 4.
Type of donation:
Sewn face coverings/masks
N95 respirators
Surgical or Procedure masks
Medical gowns
Nitrile gloves
Face shields (Business-produced or homemade)
Hand soap or sanitizer
Cleaning supplies: Disinfectant spray and wipes, bleach, etc.
Hair covers
3-D printed masks
Diapers
Toilet paper
Paper towels
Baby formula
Non-Perishable Food - Cans of food that are not expired
5.
Quantity of items to donate
 

50 characters left.
6.
Description of donation
 

350 characters left.
Thank you for your offer to donate needed supplies, these are critical to our public health and we greatly appreciate your offer and your follow thru in making this donation possible. One of our staff members will review the submission and get back to you.

If you experience problems submitting this survey, please click on this link  to re-access the survey.