COVID-19 Response & Product Needs Survey

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* 1. Organization Name

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* 2. Email

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* 3. State

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* 4. Is your organization currently a registered Good360 member?

Yes

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* 5. What type of relief or support are you currently providing in response to COVID-19? Check all that apply.

Distributing supplies or providing services to hospitals, clinics or other healthcare providers.

Distributing supplies or providing services to people economically impacted by COVID-19.

Providing support to children impacted by school closures.

Providing support to vulnerable populations impacted by COVID-19. (ex: elderly, immuno-compromised)

Other (please specify)

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* 6. What product are you currently interested in sourcing for those in need in your community?

Cleaning Supplies (ex: Lysol wipes, Bleach, Pine Sol)

Personal Care Products (ex: soap, shampoo, deodorant, toothpaste)

Toilet Paper/Paper Towels

Personal Protective Equipment (ex:masks, gloves, gowns, etc.)

Hand Sanitizer

Ventilators and other medical supplies

Mattresses

Technology (ex:computers, laptops, tablets)

Clothing/Underwear/Shoes

Books/Toys/Games

Furniture

Baby Diapers/Wipes

Home Goods/Household Products (ex: small appliances, lighting)

Over the Counter Medication

Bedding (ex: sheets, pillows, comforters, blankets)

Building Supplies

Other (please specify)

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* 7. What is your current receiving capacity?

500 square feet of storage space or less.

500-10,000 square feet of storage space.

Over 10,000 square feet of storage space.

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* 8. Would you like to receive future updates and surveys regarding COVID-19 response and needs?

Yes

COVID-19 Response & Product Needs Survey

Question Title

* 1. Organization Name

Question Title

* 2. Email

Question Title

* 3. State

Question Title

* 4. Is your organization currently a registered Good360 member?

Question Title

* 5. What type of relief or support are you currently providing in response to COVID-19? Check all that apply.

Question Title

* 6. What product are you currently interested in sourcing for those in need in your community?

Question Title

* 7. What is your current receiving capacity?

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* 8. Would you like to receive future updates and surveys regarding COVID-19 response and needs?

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* 9. Do you have any comments, questions, or suggestions for Good360?