• MasksOn.org Request Form

    MasksOn.org Reusable Face Shield is a Face Shield for Medical Purposes - authorized by the FDA's Emergency Use Authorization (EUA) for face shields. Please check MasksOn.org for instructions, important warnings, and frequent updates.
  • Due to greatly increased demand and nearly exhausted inventory / funds, your request will be added to a waitlist. We can no longer guarantee that you will receive a face shield or when it will be delivered.

    If you are able, a donation will extend our ability to donate face shields to clinicians: https://maskson.org/donate

     

    • This device is only for use when FDA-cleared masks or respirators are unavailable
    • This device is intended for multiple uses by the same user
    • This device requires an airway filter certified for "Bacterial/Viral" filtration (not included)
    • This device cannot be used while wearing eyeglasses
    • Read all clinician information and warnings at https://MasksOn.org before proceeding
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    • Healthcare Affiliated  
    • Mask Selection

      Use the chart below to determine the correct mask size. Picking the correct size is important for getting a good face seal. Order only one mask per person. If you have not ordered the "MasksOn.org Reusable Face Shield" for testing previously, you will be limited to 6 masks.
    • 1 Shield For My Use  
    • The Model 110 Reusable Face Shield comes in 2 sizes: 
      Measure from chin to eye line to determine size.

      - "S/M" - Less than 4.7 in (12 cm)
      - "L/XL" - Greater Than 4.7 in (12 cm)

      The Face Shield is reusable, each person needs only one.

    • New Clinician Testing  
    • The Model 110 Reusable Face Shield comes in 2 sizes: 
      Measure from chin to eye line to determine size.

      - "S/M" - Less than 4.7 in (12 cm)
      - "L/XL" - Greater Than 4.7 in (12 cm)

      The Face Shield is reusable, each person needs only one.

    • Max test quantity of 6 masks - please adjust request.

    • Returning Clinician  
    • The Model 110 Reusable Face Shield comes in 2 sizes: 
      Measure from chin to eye line to determine size.

      - "S/M" - Less than 4.7 in (12 cm)
      - "L/XL" - Greater Than 4.7 in (12 cm)

      The Face Shield is reusable, each person needs only one.

    • Max total quantity of 200 masks - please adjust request.

  • REQUESTS RECEIVED WITHOUT VALID SIGNATURE ON "LETTER OF UNDERSTANDING AND INDEMNIFICATION" WILL NOT BE FILLED.

    questions@maskson.org 

     

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    Pick a Date  :
  • Letter of Understanding & Indemnification

    In response to, and in consideration of, the COVID-19 emergency, by signing this Letter of Understanding below, you, on behalf of and in connection with your role at: {healthcareInstitution} a healthcare facility or healthcare provider (“Provider”), understand and agree to the following terms and conditions with respect to the order of Masks On Corporation and any instructions related to the use thereof (the “Component Parts”) made by Provider on {date} and supplied to Provider by Masks On Corporation, a Massachusetts not for profit corporation to be formed, or any of its volunteers, contributors, partners, agents, or representatives (collectively “Masks On”) (see MasksOn.org):

    1.     Provider understands that all Component Parts provided by Masks On are either (i) generic components, (ii) parts manufactured pursuant to specifications provided by Provider to Masks On, or (iii) requested as-is at the instruction of the Provider.  Both Parties agree that such Component Parts provided by Masks On are not and do not constitute finished medical products.

    2.     Provider shall solely determine how such Component Parts are used and shall use such Component Parts at Provider’s sole discretion.  

    3.     Provider understands that Masks On is currently not a registered/licensed medical device manufacturer with the U.S. Food and Drug Administration (“FDA”) or any applicable ANY regulatory agency. 

    4.     Provider understands and agrees that Masks On has not conducted performance testing, functionality testing or validation testing with respect to the Component Parts or use of Component Part for any purpose, including biocompatibility testing that may be relied upon by Provider. Any such testing, if required, shall be the sole responsibility of Provider.

    5.     Provider understands and agrees to indemnify and defend Masks On for all costs and liability, including attorney fees and all regulatory compliance and liability, related to the supply and use of Component Parts provided by Masks On, any Provider specifications for the Component Parts, distribution of the Component Parts or other products that incorporate the Component Parts by Provider.

    6.     Provider understands and agrees that the Component Parts are provided on an “as is” and “as available” basis, and without any representation, warranty, guarantee or condition of any kind whatsoever, whether express, implied or statutory, including without limitation any implied warranties of merchantability, fitness for a particular purpose, satisfactory quality, quiet possession, title, quality of service, non-infringement, or that otherwise arise from a course of performance or dealing, or usage of trade, all of which are hereby disclaimed by Masks On.

    7.     The undersigned agrees and acknowledges that he/she/they are signing on behalf of Provider and in relation to any use of the Component Parts by Provider or any representatives of Provider, and that Masks On may rely on the undersigned’s authority to bind Provider regarding the use of such Component Parts.

    ACCEPTED AND AGREED as of {date}

    {healthcareInstitution}, {yourContact}, {yourEmail}

    NAME OF PROVIDER

    {typeA}

    SIGNATURE

    {yourRole}

    TITLE

  • AFTER YOU FINISH SIGNING IN DOCUSIGN PLEASE BE SURE TO CLICK THE BLUE "CLOSE WINDOW" BUTTON IN THE MIDDLE OF THE SCREEN TO ENSURE YOUR REQUEST IS RECEIVED.

    REQUESTS ARE PROCESSED IN THE ORDER THEY ARE RECEIVED BY A VOLUNTEER TEAM. YOU DO NOT NEED TO REACH OUT TO FIND OUT IF YOUR REQUEST HAS BEEN RECEIVED - WITH VALID EMAIL YOU WILL RECEIVE A COPY.

    YOU WILL HEAR FROM US WHEN YOUR REQUEST IS PROCESSED OR IF WE NEED MORE INFO.

  • Letter of Understanding & Indemnification

    In response to, and in consideration of, the COVID-19 emergency, by signing this Letter of Understanding below, you, on behalf of and in connection with your role at: {healthcareInstitution} a healthcare facility or healthcare provider (“Provider”), understand and agree to the following terms and conditions with respect to the order of Masks On Corporation and any instructions related to the use thereof (the “Component Parts”) made by Provider on {date} and supplied to Provider by Masks On Corporation, a Massachusetts not for profit corporation to be formed, or any of its volunteers, contributors, partners, agents, or representatives (collectively “Masks On”) (see MasksOn.org):

    1.     Provider understands that all Component Parts provided by Masks On are either (i) generic components, (ii) parts manufactured pursuant to specifications provided by Provider to Masks On, or (iii) requested as-is at the instruction of the Provider.  Both Parties agree that such Component Parts provided by Masks On are not and do not constitute finished medical products.

    2.     Provider shall solely determine how such Component Parts are used and shall use such Component Parts at Provider’s sole discretion.  

    3.     Provider understands that Masks On is currently not a registered/licensed medical device manufacturer with the U.S. Food and Drug Administration (“FDA”) or any applicable ANY regulatory agency. 

    4.     Provider understands and agrees that Masks On has not conducted performance testing, functionality testing or validation testing with respect to the Component Parts or use of Component Part for any purpose, including biocompatibility testing that may be relied upon by Provider. Any such testing, if required, shall be the sole responsibility of Provider.

    5.     Provider understands and agrees to indemnify and defend Masks On for all costs and liability, including attorney fees and all regulatory compliance and liability, related to the supply and use of Component Parts provided by Masks On, any Provider specifications for the Component Parts, distribution of the Component Parts or other products that incorporate the Component Parts by Provider.

    6.     Provider understands and agrees that the Component Parts are provided on an “as is” and “as available” basis, and without any representation, warranty, guarantee or condition of any kind whatsoever, whether express, implied or statutory, including without limitation any implied warranties of merchantability, fitness for a particular purpose, satisfactory quality, quiet possession, title, quality of service, non-infringement, or that otherwise arise from a course of performance or dealing, or usage of trade, all of which are hereby disclaimed by Masks On.

    7.     The undersigned agrees and acknowledges that he/she/they are signing on behalf of Provider and in relation to any use of the Component Parts by Provider or any representatives of Provider, and that Masks On may rely on the undersigned’s authority to bind Provider regarding the use of such Component Parts.

    ACCEPTED AND AGREED as of {date}

    {yourContact}, {yourEmail}

    NAME OF PROVIDER

    {typeA}

    SIGNATURE

    {yourRole}

  • Clear
  • Due to greatly increased demand and nearly exhausted inventory / funds, your request will be added to a waitlist. We can no longer guarantee that you will receive a face shield or when it will be delivered.

    If you are able, a donation will extend our ability to donate face shields to clinicians. Please see https://maskson.org/donate

  • FORM ENTRY DOES NOT MEET MASKSON.ORG REQUIREMENTS. 

    Please visit MasksOn.org for more information or email questions@maskson.org

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