Bloodborne Pathogen Exposure Control Order Form

Bloodborne Pathogen Exposure Control Order Form
Use this form to order exposure control supplies related to bloodborne pathogen safety. Complete all fields to ensure accurate and timely processing.
Full Name of Requester
First NameLast Name
Requester Email Address
example@example.com
Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Department or Unit
Delivery Location
Preferred Delivery Date
MonthDayYear
Date
Urgency Level
Exposure Control Supplies Order
prevnext( X )
Biohazard Bags (Box of 100)
Red, labeled, leak-proof bags for biohazard waste disposal.
$28.00Quantity

Sharps Containers (1 Gallon)
Puncture-resistant containers for safe sharps disposal.
$16.50Quantity

Disposable Nitrile Gloves (Box of 100)
Powder-free, non-sterile gloves for exposure control.
$14.75QuantitySize

Protective Gowns (Pack of 10)
Fluid-resistant disposable gowns for personal protection.
$22.00Quantity

Face Shields (Pack of 5)
Full-face protection shields for exposure control.
$18.00Quantity

Total
$0.00
Order Reference Number (if applicable)
Special Instructions or Order Notes
Acknowledgement of Order Purpose
Should be Empty: