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Agency/Organization PPE Request Form

The Weld County Emergency Operations Center is working with public health officials to provide personal protective equipment (PPE) to critical health facilities and first responders who are in direct contact with presumptive positive or confirmed positive patients.

We currently only have minimal supplies to assist these critical need agencies. Businesses looking to reopen following the governor’s guidelines need to be able to procure their own masks, gloves and cleaning supplies.

Please fill out one form for each type of item being requested. For example, if you need gowns and masks, please fill out one form for the gowns and another form for the masks.

To fill out the form:

  • Click here to open the form in a new window
  • Right click on the form and save as a PDF
  • Fill out the form and save again
  • Click "submit" OR email the completed PDF form to