Critical Supplier Questionnaire

Personal Protection Equipment (PPE)

Getting Emergency Supplies To The People That Need Them Most.

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* 1. What is the name and address of your company/organization?

Company Name

Address 1

Address 2

City, State, Postal Code, Country

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* 2. Who is the best point of contact at your company/organization?

Full Name

Address

Telephone

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* 3. Are you a manufacturer or a distributor?

Manufacturer

Distributor

Both

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* 4. If a distributor, where is your network of manufacturing facilities generally located? (State/Province and Country)

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* 5. What personal protective equipment (PPE) can you supply? (check all that apply)

Respirators N95 (United States NIOSH-42CFR84)

Respirators KN95 (China GB2626-2006)

Respirators FFP2 (Europe EN 149-2001)

Respirators P2 (Australia/New Zealand AS/NZA 1716:2012)

Respirators DS (Japan JMHLW-Notification 214, 2018)

Respirators Korea 1st Class (Korea KMOEL - 2017-64)

Surgical Masks FXX

Surgical Masks with antimicrobial/antiviral agent (OUK)

Pediatric/child facemask (OXZ)

Surgical Gowns (FYA)

Isolation Gowns and Surgical Apparel Accessories (FYC, LYU, OEA)

Surgical Suits (FXO)

Other (please specify)

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* 6. Do you have proper Documentations and Certifications for the selected products you can supply? (FDA/NIOSH/CE/etc)

Yes

Other (please specify)

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* 7. Can you provide recent photos and short video of the product(s)?

Yes

Other (please specify)

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* 8. What is your estimated capacity limit on volume daily?

100,000

500,000

1,000,000+

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 9. What geographic locations can you ship to?

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* 10. What are acceptable payment methods?

Pre-pay

Deposits

Collect on Delivery

Escrow

Invoice Net 15

Invoice Net 30

Other (please specify)

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* 11. TURNAROUND TIME: How fast can you process and ship an order being delivered to or within the United States?

1-2 days

2-3 days

3-4 days

4-5 days

5-6 days

6 days or more

Other (please specify)

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* 12. How much operating experience does your organization have in supplying/manufacturing these products?

less than 1 year

1-3 years

3-5 years

5-10 years

10+ years

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* 13. In the meantime ... please send pictures and videos of your product to verification@criticalsuppliers.org . Also include pricing, any certifications, and documentation to expedite the process. Please add any questions here and we'll answer them promptly: