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Ventilator Survey

Due to a shortage of ventilators and urgent public need, Governor Cuomo has issued an executive order requiring all unused ventilators or equivalent devices to be reported and made available to the state. Any institution, office, or person whose ventilator or equivalent device is used by the state will have their ventilator or equivalent device returned to them in the same condition, be provided with a newer replacement device, or receive financial compensation from the state to purchase a replacement. Please fill out the following information and you will be contacted to arrange pick up of your device if it is needed. Thank you.

A copy of the certification will need to be provided when the ventilators are collected.

Best Points of Contact to Arrange Pick Up of These Machines and/or Who Have Access to the Premises Where These Machines are Located

Select all that apply

What Quantity and Type of PPE Do You Have Available? Please Estimate Individual Units, Not Boxes or Cases.